
Originally Posted by
Tyche
End stage liver failure, in my opinion, would probably be the worst disease to live with. It’s an awful life. The most effective medication to take gives you uncontrollable diarrhea. Your liver can’t process ammonia to convert to urea, so ammonia builds up in the blood to sometimes dangerous levels. To rid yourself of ammonia, there’s a few options. The cheapest and most effective is lactulose. This medication pulls ammonia from the blood and into the colon to be shat out.
If you aren’t compliant with the medication to stabilize the ammonia buildup, or other factors like electrolyte imbalances, infection, or a GI bleed cause ammonia to elevate, the ammonia will work its way to your brain where it’ll cause hepatic encephalopathy. This causes intense confusion, sleep problems, irritability. It’s dementia x10. To get the ammonia levels in check, we often have to shove tubes from patients mouths/nose to their stomach and dump in lactulose because the patients may have difficulty understanding how to take their meds or they are obtunded and unresponsive and cannot take the medication on their own. Regardless, they certainly are not able to figure out how to use a toilet…so they shit themselves non-stop.
On top of all of that, the liver cannot filter blood quickly and, like a traffic jam, blood will back up. It backs up to the esophagus, which causes the vessels in the esophagus to become engorged (esophageal varicies) which can “pop” and cause a large bleed into the GI tract which can only be fixed with an endoscope. This bleed can also cause ammonia levels to rise, exacerbating the hepatic encephalopathy. I’ve popped varicies putting down a tube to their stomach. It’s not a good time for anyone.
It’s a miserable existence. Don’t be an alcoholic.