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ammonia Maybe Hepatic Encephalopathy?
Jul 25, 2004

I asked about the ammonia levels because I had in the past 4 weeks on and off a numbness that stared at the base of my neck and traveled up through to the front of my head almost losing unconsusiousness 4 times and losing unconsusiousness once for a few minutes. I have an enlarged spleen, intense abdominal pain, and intense Upper Left & Upper Right Quad pains, chest pains, those are daily but the location can be all of them or just a few exspecially my abdominum. A constant headach for the past week. I have gianed 15lbs in the past 3 weeks but my eating had not increased. I was over weight to begin with and had just lost 30lbs due to the inability to eat from nausesnous. My stool is a light coloered yellow and sometime when I clean myself there is a very bright colored red blood on the tissue sometimes it seems watery and I have an enlarged spleen and am a type 2 diabetic which I am know having trouble controling and according to one doctor my symtoms and other symptoms match Hepatic Encephalopathy (my mother died of Hep C cirhosis and I watched her Encephalopathy develope and I and my family see some of the same signs she started having in me). My biopsy had me with bridging fibrosis as a 3/4 over a year ago. The pain and loss of unconsusiousness was bad enough to bring me to the emergency room without insurance. I was not seen by I heepatologist or Gastronologist but the regular Internest who said she could not tell what my pain was discharged me and told me to see a Gastronologist, she did tell me she thinks I have cirhosis but my liver is still compensating. I also told her I was suicidal up to a day ago (still am, anything will beat having this pain). My ammonia was 38 I know that blood ammonia does not compare to the actual amount of brain ammonia. All other blood tests were ok but at the high or low ends whichever was worse for that particular test. I feel full and bloated all the time. Nothing was done to check for asceties. I got a follow up appointment with Family Practice were I will not see a Gastro but most likely a GP. I am hoping to get emergency Medicaid to pay for the ER visit. I was already turned down by Medicaid and had walked off my job in late Febuary, it was very stressfull and I had been showing eratic behavior, irritability, and aggitation so I got turned down for unemployment. I have yet to see a doctor or hospital do something for free. My question is this. What questions should I ask the GP when I see him/her on the 30th?

Response from Dr. McGovern

Your case is very complicated and it is difficult for me to advise you fully. I would not worry about what questions you need to ask the physician. I would think about and write down the symptoms you have been having in a chronological form and so when you go to the doctor's office, you will remember all the important details so that your physician can have a good medical history. I would also bring any medical records you may have from other places. Your physician will then perform a thorough physical examination and will obtain the appropriate laboratories to assess your condition. With all this information your physician will be able to help you with your liver disease.

Dr. McGovern



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