Is there possibly different scales for this?
My best friend was hospitalized for acute liver-badness after her son was born. Her bilirubin level was 17 at it’s very highest and she was yellow like a banana.
(She’s totally fine now, and the cause of the liver-badness was never determined. It got really bad, and then it just went away.)
Indeed there are. You’re friend was using mg/dl, whereas the Wiki link used umol/l. The conversion factor is mg/dl X 17 = umol/l. So, your friend’s level was 17 X 17 = 289. Oh yeah. Like a banana. Or a very strange mustard.
Indeed. I sent her some Black-Eyed Susans to cheer her up ('cus I’m kind of twisted like that) and they matched her face perfectly.
My mom supposedly had severe jaundice during an illness as a child, turned bright yellow. Recovered and lived into her late 70’s with no further liver problems (and she had a cocktail after dinner every night, so it wasn’t because she was a teetotaler). So, yeah, you can have a severe liver problem and recover more or less completely. But it all depends on WHY your liver is having a problem. The problems from an acute illness are very different than those brought on by alcohol abuse, and the prognosis is likewise different.
Yes, but most of the people I know with Hepatitis C in the U.S. got it from blood transfusions prior to the early 1990’s, which hasn’t stopped a lot of ER personnel from treating them like lying junkies, so do please remember that IVDU is not the only route to HCV.
Susan, I’m sorry if I was offensive. I was just wondering if he had both because he is so sick. I should have left the word junky out of it. I am in the program so I see a lot of Hep C along with Alcoholism in the halls. Drugs and alcohol go hand in hand for a lot of folks. This man may not even have it.
The problem with Hep C is that it is not always caught early. Early treatment has good results. I have buried a couple friends from liver cancer that had advanced Hep C and were not treated in time. Hep C likes to turn into liver cancer. Everyone should have blood work done to rule out things like this.
raises hand What is the fluid that is getting drained and where is it getting drained from exactly? I assume it’s some kind of serous fluid, but where is it accumulating and why?
Okay, first please look at this picture (the drawing on the left). That shows a side view of the body, as if the person had been sliced from head to bum in a plane parallel to the bum crack. Normally, the outside of the loops of intestine touches the inside of the abdominal wall. The membrane on the outside of the intestine loops is labeled as ‘visceral peritoneum’ in the picture, and the membrane on the inside of the abdominal wall is labeled ‘parietal peritoneum’. Normally, these two membranes touch each other and there is nothing between them except a lubricating bit of fluid (which is not the case in this picture - see below).
Now, see the blue-gray coloring? That is supposed to represent fluid that’s accumulated in the (potential) space between the two peritoneal membranes. In this particular picture, the fluid is from dialysis but that’s beside the point. In liver disease, fluid accumulates in exactly the same place and it’s called ASCITES. People with big-time ascites look like this. Notice in that photo the disparity between the wasted looking hands and the huge belly.
In terms of why it accumulates in cirrhosis, that’s a bit harder to explain because a key mechanism hinges on understanding about pressure gradients in the body and, more specifically, in the blood vessels. Suffice it to say, that among the manifold mechanisms for ascites formation, an important one is due to scarring within the liver. The scars therein compress the veins in the liver and that raises the pressure in those veins and, in turn, the veins going into the liver. This high pressure acts as a force to extrude water from the veins (and remember that the walls of vessels are relatively permeable to water but, of course, the cells must remain inside).
Hope this helps.
Most folks don’t even get sick when they get infected acutely with the Hep C virus, so it’s difficult to identify them. I was discussing this very situation with the UWisconsin Hepatology folks two days ago, and they rarely get the opportunity to treat someone in the first 6 months of their infection, when cure rates reach 90%. Personally I’ve only had one patient myself who was identified to be an acute infection.
And once the infection is chronic (present longer than 6 months) the cure rates drop enormously. If you’re lucky enough to have genotype 2 or 3 (uncommon in this country), the cure rate may be 80%, but if you have genotye 1, then the cure rate is generally under 40%. And that’s after a year of weekly interferon injections and daily ribavirin doses which tend to make you quite ill, and cost tens of thousands of dollars, too.
The good news: Hepatitis C generally only kills 4-5% of the people that have it; the rest will live with the disease and die of something else. Unfortunately, 4-5% is still a very high number, given the prevalence of the disease.
The other good news: New antivirals are coming out within the next few years, to be taken with interferon and ribavirin, which look to raise the cure rate and shorten the treatment time.
Also be aware that Hepatitis C itself does NOT directly cause hepatoma (unlike hepatitis B). The hepatoma is due to the cirrhosis, and only 20% of people who have hepatitis C get cirrhosis. Even so, Hep C patients need ultrasounds or other studies once or twice a year to screen for hepatoma.
Things really go to hell if a person with Hep C continues to drink alcohol. Or has a co-infection with Hep B, or HIV.
Who should be screened for hepatitis C? Basically, those with risk factors such as sharing of needles, IV drug users, sharing of cocaine straws (the exact mechanism here isn’t quite clearly understood), dialysis patients, organ transplant patients, those that got blood or blood products prior to 1992, folks with elevated liver enzymes on blood testing, those who have HIV or Hep B infections, and those who have intimate contact with Hep C patients.
Fortunately Hep C is not real easily passed via sex. Recent studies indicate the following: A woman who has a monogamous sexual relationship with a Hep C infected man, and doesn’t use condoms, but avoids high risk sexual practices (anal sex, etc) has only a 0.6% chance of picking up the virus per year. Of course, after 10 years of doing that, the risk has risen to 6%, but even so, the odds aren’t horrible.
Sorry about all that, I just got done re-writing our department’s screening and monitoring protocol for Hepatitis C. So I’ve been thinking about it a LOT.
Interesting stuff. I am going to get a Hep B shot because of my work. My doctor suggested it but it was not covered by insurance and took a pass on it. After reading and looking at Karls Photos I am going to get one. Good news on the new vaccine. People really suffer on the year long protocol. As you said to drink with Hep C is a killer.
Another thing I notice is a higher incidence of Pancreatic cancer in heavy drinkers. A friend of mine just lost her husband to it and it is a quick and deadly form of cancer. There is no cure for it and when she told me he had it I was so devastated for her. I told her to take him on a vacation but the hospital wanted to do a procedure. I don’t even think he made it 4 months. I worked with a man that drank a fifth a night of vodka and one day he started complaining of having a fat leg. I told him he should get it checked out. It was Pancreatic cancer. He was told to go take a vacation in Malta with his wife but instead he looked into alternative cures. He was gone in 6 months. Patrick Swazey recently died of this. I don’t think Patrick Swazey was a drinker. A real shame.
No apologies necessary; it was a good, informative read.
Sorry to resurrect this. But he died yesterday.
Oh, that’s sad.
Sorry to hear that, Crafter_Man. So he made is two years. Can you tell us more? Did he have a period of remission? Poor bastard.
My alcoholic uncle turned yellow and died just before Christmas. Very fast.
So sorry. But he lasted nearly 4 years. Pretty good for ESLD that sounds like it was decompensated back in 2010 and before.
Did he manage to stop drinking?
I’ve lost a LOT of patients to ESLD from HCV + EtOH in the last 4 years.
Four years, not two.
I went through all that- the ascites, encephalopathy, yellow skin. The cause for me was NASH, a form of cirrhosis not caused by alcohol. A transplant saved my life. I hope your co-worker can be saved.
My condolences, Crafter_Man.
I have alcoholic hepatitis and I took livolin forte for three months. One bottle of pale pilsen a day is my current limit. I used to do 3-4 in the last 5 years.
It’s what i get for not reading the whole thing. My condolences. I’m so grateful they caught my problem in time, and sorry they didnt catch your friend.
