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Gastroenterology (Expert Forum)
What to expect
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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What to expect
by tntracie, Nov 19, 2005 12:00AM
My father is 83 years old and his doctor strongly suspects he has liver cancer due to recent blood tests (ALK Phosphatase 661; AST 180; ALT 179; BUN 46; Creatinine 1.8; Bili, total 9.2) and his symptoms: In the past week he has been sleeping most of the day and eats very little. He is extremely jaundiced and his urine is brown. His abdomen appears swollen and he has frequent hiccups. He is having trouble walking and appears confused some of the time. He states that he is not in pain. He has always abstained from alcohol, but his father and brother (who were both alcoholics)died of liver cancer.
The doctor cannot give a definite diagnosis w/out more testing. He wants to admit my father to the hospital and my father refuses. He had a stroke three years ago and has been in bad health ever since. Considering his age, quality of life, and wish to stay at home, we have decided not to force him to go to the hospital unless we see that he is starting to have pain. His doctor did not press the issue and stated that "If you have to die, this isn't a bad way to go."
My questions:
(1)I fully understand that you (like his doctor) cannot give a diagnosis without all the facts, and this question is not asking you to specifically address my father's situation. I would like a general synopsis of the last stages of liver cancer and what someone with liver cancer should expect in the final days. Again, I am not asking specifically about my father, as I know it would be inappropriate for you to give a prognosis based only on what I've told you.
(2)His doctor did not say if there are other conditions with these symptoms. What are the other conditions could his symptoms be indicators of?
The doctor cannot give a definite diagnosis w/out more testing. He wants to admit my father to the hospital and my father refuses. He had a stroke three years ago and has been in bad health ever since. Considering his age, quality of life, and wish to stay at home, we have decided not to force him to go to the hospital unless we see that he is starting to have pain. His doctor did not press the issue and stated that "If you have to die, this isn't a bad way to go."
My questions:
(1)I fully understand that you (like his doctor) cannot give a diagnosis without all the facts, and this question is not asking you to specifically address my father's situation. I would like a general synopsis of the last stages of liver cancer and what someone with liver cancer should expect in the final days. Again, I am not asking specifically about my father, as I know it would be inappropriate for you to give a prognosis based only on what I've told you.
(2)His doctor did not say if there are other conditions with these symptoms. What are the other conditions could his symptoms be indicators of?
Doctor's Answer
by Kevin Pho, MD, Nov 21, 2005 12:00AM
, Nov 21, 2005 12:00AM
To answer your questions:
1) Advanced liver disease can lead to several manifestations. It can cause kidney failure (hepato-renal syndrome), upper and lower GI bleeding (increased portal pressure leading to esophageal varices or lower GI bleeding), bleeding disorders, mental status changes, as well as an increased risk of abdominal infections (peritonitis). This is just to name a few. An ultrasound would be the initial test to evaluate these lab values.
2) Other than liver cancer, one can consider problems with the biliary duct, pancreatic disease/cancer, gallstones, or gallbaldder disease/cancer.
These considerations can be discussed with your perosnal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
1) Advanced liver disease can lead to several manifestations. It can cause kidney failure (hepato-renal syndrome), upper and lower GI bleeding (increased portal pressure leading to esophageal varices or lower GI bleeding), bleeding disorders, mental status changes, as well as an increased risk of abdominal infections (peritonitis). This is just to name a few. An ultrasound would be the initial test to evaluate these lab values.
2) Other than liver cancer, one can consider problems with the biliary duct, pancreatic disease/cancer, gallstones, or gallbaldder disease/cancer.
These considerations can be discussed with your perosnal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
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