Fao Sqad - Urgent

[NoMercy]

Hi Sqad. I would appreciate your thoughts, despite not being able to give too much info at present.

My mother's twin sister became acutely unwell this morning and she is now in intensive care. She was vomiting blood and Doctors say she has a tear / bleed going on somewhere. Her liver is badly inflamed and her kidneys aren't working.

She had an emergency endoscopy this afternoon and we are awaiting the results but prior to the procedure, the Doctor doing the rounds said he would give her a 30/70% chance of survival and stated that the next couple of days are "crucial"

She's a chronic alcoholic. In recent weeks shes been experiencing back pain and shooting pains in all 4 limbs but has refused to seek medical attention.

I know what my thoughts are but would appreciate your thoughts here.

[chrissa1]

I know exactly what you’re talking about because my late husband went through this. He was in intensive care for about two days. He was a very heavy drinker and I’m afraid it claimed his life two years after this episode.

I’ve been scanning back through my questions to see if I asked a question about it but couldn’t find anything.

He was diagnosed with something called an M????? Syndrome and I’m so sorry, I can’t remember the name of it. Sqad will know. My late husband came through it alright, but it is caused by heavy drinking and your sister has to stop drinking, now.

MALLORY VICE!!!! It has just come back to me. Google it until Sqad can give you more advice.

[chrissa1]

Sorry...... Mallory Weiss.

[EcclesCake]

What is her C-P count?

[ummmm]

Mallory Weiss can be associated with a few conditions according to google including morning sickness and bulimia. I couldn't see a mention of it in relation to the kidneys.

[chrissa1]

Ummmm, all I know is that my Kate husband abused alcohol and when he was in the ICU that’s what they diagnosed as being the cause of his problems.

He eventually succumbed to liver cirrhosis and while he was in hospital at the end, his urine was a dark colour and virtually non-existent. Kidneys were definitely damaged.

[chrissa1]

Sorry ^^^^^ “late.”

[Sqad]

Sorry NoM...I just needed off in the chair.
She has ruptured oesophageal varices (varicosed veins)secondary to portal hypertension (high BP in the Portal vein)which is all secondary to due cirrhosis of the liver commonly but not always due to chronic alcoholism.
chrissa.....Mallory-Weiss Syndrome is rupture of oesophageal varices without the accompanying situation that I have mentioned above.

NoM...this is a BIG DEAL and a *** to control...normally dealt with by a balloon down the gullet and then inflated. Blood loss and shock is the main problem and the prognosis is poor......SORRY.

[ummmm]

My dad died in a similar way but wasn't an alcoholic.

[ummmm]

That was to Chrissa.

[chrissa1]

So sorry NoM.

[NoMercy]

Thanks everyone for your replies. Sqad - I suspected as much. Mum asked my thoughts and I said that this was, essentially, the beginning of the end.

[EDDIE51]

^ I am sorry but I have to admit I agree with you.

[rowanwitch]

Hi, first if they control the bleeding, probably with a sengstaken tube, it might be possible for her to have a TIPS procedure to reduce the intrahepatic pressure, this can buy a fair bit of time although it is often at the cost of a degree of ongoing encephalopathy. I know they do this in Birmingham, and other major liver units. Depends on if she is stable enough for transfer. Maybe better if this didn't happen if there is little or no chance she would give up drinking afterwards . Thoughts with you. Rowan xx

[EcclesCake]

Would TIPS serve much purpose at this stage Rowan?

[Sqad]

Eccles.....yes......this might be the next stage, but may have to be postponed until she is fit as the procedure, although done under local anaesthesia may take fro 2 hours to up to 6 hours if the anatomy is difficult.

[rowanwitch]

Not a lot of help if the lady continued to drink, but it could buy enough time for no mercy's mum to spend time with her sister. I have seen TIPS patients survive to be discharged from hospital but they were fairly well prior to the bleed. I know some of my ex out colleagues felt it was also a less distressing end for families to see than the activity surrounding someone who dies from a variceal bleed. It's just an option that may be out there but it may already be too late.