Can part of a liver sufferning chirrhosis be removed?

Thank you for your response.  We are meeting with the doctor next Thursday to discuss options because he has been getting better and improving more than expected.   My brother was originally at one hospital in hospice care. I got him transfered down to NYC and he has improved dramatically.  He not able to handle a diuretic and was having paracentesis once a week to remove 7-8 liters.  Now that he is getting better, she wants to try the diuretic and lessen the amount of time he gets "tapped".  She mentioned a possible stent to redirect the fluid.  Any suggestions on questions I should ask?

If you would like to give me slightly more detail to go on, it would help.

I have ALD, and what is first stage cirrhosis. So I know a fair bit about it from experience and I had aa stint in hospital, but no where near as bad as your brother.

Is this down to alcohol, how old is he, what has the doctor said about him, prognosis etc and what other treatment medication is he having.

"Pparacentesis" is not a British phrase, but I gather that is an ascites drain. You did the right thing getting him out of a hospice, because there is only one thing they deal in and it is not long term life care.

Yes, it is alcohol related but he has been under supervised care for over a year.  He has not drank alcohol during this time.

You are also correct, he gets an acites drain every week.  

He was at a hospital in a different part of the state.  This hospital denied him as a canidatefor a transplant.  They told me that his liver was not functioning and with that, his kidneys would soon cease to function.  They moved him to hospice and told me that he would survive 2 weeks at the most (this was in September of last year).  He hung on and the doctors did not know exactly what to do.  I was fortunate that there was someone on team that searched for another transplant hospital who accepted him.

When he arrived at the new hospital he was bleeding internally and they discovered that he had a blood infection.  This prohibited him from being on the transplant list.  It took about a month of anitbotics to clear the infection.  During this time, the were able to band his bleeding and get his amonia levels under control.  

When he arrived at the hospital, his MELD score was so high that he would have been at the top of the list for a transplant.  Once they got his health in better shape, the score dropped, but he was still pretty high. They thought maybe 2 or 3 months to be called.

At this point, he had been bed ridden for so long, he could not walk.  They sent him to a rehab  center for a few weeks until he was able to get around with a walker.   In January he was relased from the hospital.

He is getting his ascites treated every week and in the beginning they were taking off 7 to 8 liters a week.  He has been walking every day and now 8 months later, his MELD has dropped to a level that he most likely will not be called until his condition worsens again.  Because of his progress, the doctor (who we see next week) is going to try to put him on a duiretic.  She previously was hesitant because of his kidneys.  She tests his blood weekly and from recent readings feels his kidneys are doing better.

Next week we are also going to discuss possibly adding a stent to control the fluid build up.  They had talked about this at the previous hospital but took it off the table as being too risky.  I  guess the main concern is infection.

If anyone has any suggestions on what questions I should ask or any options we may have it would be greatly appreciated.

It has been a long road from being told their is no hope to being cautiously optimistic.

Also, I should add, we are in NYC which is one of the worst places to wait for a transplant.  Resources are limited and demand is high.  His insurance is limited to the state of NY so we can not leave the state to go somewhere with a shorter wait list.

If he was bleeding internally, that suggests portal hypertension and oesophageal varicies. Clamping would confirm this, if it is slightly less serious, they can use medication. It is also quite common to get infections when you have ascites. The ammonia levels are from the liver not being able to remove the toxins from the body. I would imagine your brother is on latulose to stop hepatic encephalopathy and also it is helpful in renal failure.

The diuretic should help with the ascites. I guess with the stent, it is also the risk of the operation on someone who is not well and the use of GA.

As for questions, diet is very important. You need a good balance of protein, fat and carbs. Previously protein was restricted in the diets of people with cirrhosis, because of the concern over ammonia. But protein is actually very important and lack of it can lead to protein calorie malnutrition. When i came out of hospital, I was sent as an outpatient to the acute dietician at the hsopital, and she went trhough all the do's and don'ts. Each individual needs a different diet. For instance, I have no problem with my kidneys, so i do not need to worry about anything that effects them. One thing for all people with cirrhosis is, that their liver cannot store energy for more than two hours. Therefore they need to eat little and often. The days of eating a Full English breakfast and skipping lunch have gone. If the liver does not get energy, it cannabilises other stores such as muscle energy stores which increases fatigue. So, if you have not already seen a hospital dietician, I would ask for an appoitment. It needs to be the hospital dietician, so they have access to all the hospital records.

As for other questions, I would just keep asking, never assume you will be told things. I have always had to go digging, and found things out for myself, that I felt I should have been told. Of course, until I saw what was written down about me, I had no idea which questions to ask. I had to purchase my hospital patient records and it is amazing how much they don't tell you and from that, I was able to push them on many things, including for tests to be done that were recommended but never carried out.

Prognosis is a tough one, I can virtually never get a straight answer, but it sounds like your doctor has been fairly upfront with you.

Fortunately we have the NHS and don't have to rely on insurance. Of course it can still be a postcode lottery, but I left the cities years ago and live in a fairly upmarket place, so I get seen quikcly.

Thank you for your insight, it is greatly appreciated.