Liver Cirrhosis - Hi my sister has cirrhosis due to alcohol abuse, she is in a really bad way at the

The TIPS procedure (trans-jugular intrahepatic portosystemic shunt) is designed to lower blood pressure in the portal vein using a shunt. It reduces previously very high blood pressure in the lower esophagus which has caused those (bleeding) varicosities. The varicosities are very serious and severe bleeding episodes have up to a 30% mortality rate. Bleeding heavily from the mouth or throwing up blood requires a 911 call. (I have not had the TIPS procedure as 40% of people naturally develop a recanalized para-umbilical vein which acts as a natural shunt).

The best way to help at this stage is not to be an enabler of any kind. Buying her a drink might stop a tantrum but it isn't helpful except in avoiding the argument. You have to tell her that you will not aid her in purchasing alcohol. Dying of liver disease is not like you see on TV where a healthy looking person goes yellow or ruptures an esophageal varicosity and slips away peacefully in a few days. The reality is that these stages take years; getting progressively more horrible.

Maybe if you provided her with some plain language information about the progression and symptomology in end stage liver disease (Is there a nearby (Hepatitis or Liver clinic) near you? They can often provide you with lots of information). It might encourage your sidter to try and put off the inevitability of the later symptoms which become increasingly unpleasant and finally finish with jaundice, severe brain damage, finally coma, with death following in days.

It would be helpful to have her arterial blood ammonia levels tested as high levels cause encephalopathy; these levels can be lowered by using Lactulose. As ammonia levels fall in her blood stream she would become more mentally stable (her mind may feel quite foggy at the moment) but any damage already sustained is permanent.

People can quit:

When I finally made the decision to quit drinking (the Doctor had just said to me "you'll be dead in less than 2 years... "), I quit drinking, it took about 3 weeks and was no where near as bad as I had been lead to believe (it did eat away away at me for about 4-5 months afterwards). Sadly, I discover that what I did is considered a bit unusual in the medical field.

Many people manage to abstain for a few days and then reward themselves with a drink, while others simply make some decision to keep drinking or relapse in weeks, or months. Many prefer living in a state of denial and by the time alcoholic encephalopathy is established and worsening; most of these people aren't quite as reasonable as they were. It makes things heart breaking for family members as they see a loved ones personality change and disappear.

If we fast forward to 14 months after quitting drinking my MELD (Mayo end stage liver disease) score had fallen from 22 to 14 and my INR (blood clotting time) fell from 2.1 to 1.3 (just above normal). I now have a good chance of seeing out the next 5 years and being sober allows me listing for a new liver (should I change my mind on this option).

I wish you the very best with your sister as it is another sad question from loved ones about this issue. The person at the centre of this concern often seems totally oblivious to their behaviour.

My very best wishes to you, Stephen.