Ascites and Jaundice in Elderly Patients: A Case Study

Ascites with jaundice

Please help my mother.
She is seventy-five years old and has been diagnosed with a subarachnoid hemorrhage due to an aneurysm.
She underwent surgery at Taipei Veterans General Hospital, being admitted on February 23 and having the operation on March 1.
She has been recovering consciousness at a normal pace, and her brain appears to be functioning adequately.
However, she is still in the intensive care unit with no signs of improvement.
The issues she is facing include severe ascites and jaundice, thrombocytopenia, low albumin levels, intermittent fever up to 37.5 degrees Celsius, blood bacterial infection, weakness in her limbs, poor mental status, pleural effusion in the lower lobes of her lungs, and slow gastrointestinal motility.
Although she has undergone paracentesis twice, the ascites have reaccumulated.
Ultrasound, CT scans, and blood tests have not revealed any significant abnormalities in her liver, gallbladder, spleen, pancreas, intestines, or stomach.
Her liver function tests are within acceptable limits, but she is a known hepatitis C patient.
Doctor, what is happening? How can we save her? Sincerely, Shen Jin Cheng.

Shen, 50~59 year old female. Ask Date: 2005/04/12

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! Based on the information in the letter, your mother's condition still requires close monitoring.
The current presence of jaundice and ascites raises the question of whether these issues have been determined to be due to other factors or related to hepatitis C.
If it is related to hepatitis C, treatment is necessary; however, given your mother's condition, it is not advisable to initiate treatment at this time.
We must wait until the jaundice and ascites improve and the infection is under control before considering treatment.
Therefore, the most important thing right now is to observe any changes in your mother's condition.

Reply Date: 2005/04/12

More Info

Dear Mr. Shen,
I’m truly sorry to hear about your mother’s condition. It sounds like she is facing a complex medical situation, and I understand how distressing this must be for you and your family. Let’s break down the issues you mentioned regarding ascites and jaundice, particularly in the context of an elderly patient recovering from a subarachnoid hemorrhage due to an aneurysm.

Understanding Ascites and Jaundice:
1. Ascites: This is the accumulation of fluid in the abdominal cavity, which can be caused by various factors, including liver disease, heart failure, or malignancies. In your mother’s case, the ascites could be related to her liver function, especially considering her history of hepatitis C. Even if her liver function tests are within normal limits, chronic liver disease can lead to complications such as portal hypertension, which can cause fluid buildup.

2. Jaundice: This condition occurs when there is an excess of bilirubin in the bloodstream, leading to a yellowing of the skin and eyes. Jaundice can result from liver dysfunction, bile duct obstruction, or hemolysis (breakdown of red blood cells). Given that your mother has a history of hepatitis C, it is essential to monitor her liver function closely, as chronic hepatitis can lead to cirrhosis, which may not always be evident in initial blood tests.

3. Low Platelet Count and Low Albumin: A low platelet count (thrombocytopenia) can occur due to liver dysfunction, as the liver produces many proteins involved in blood clotting. Low albumin levels can indicate poor liver function or malnutrition, which can also contribute to fluid retention (ascites).

4. Intermittent Fever and Infection: The presence of fever could suggest an underlying infection, which is common in patients with ascites, especially if there is a risk of spontaneous bacterial peritonitis (SBP). This condition occurs when bacteria from the intestines enter the ascitic fluid, leading to infection. It’s crucial to monitor for signs of infection and consider empirical antibiotic therapy if an infection is suspected.

5. Weakness and Poor Mental Status: These symptoms can be multifactorial, stemming from the underlying neurological condition, potential infections, or metabolic imbalances due to liver dysfunction.

Next Steps and Recommendations:
1. Comprehensive Evaluation: It is essential for her medical team to conduct a thorough evaluation, including imaging studies (like a CT scan or ultrasound) to assess for any obstructions in the biliary tree or other abdominal organs. Additionally, a paracentesis (removal of fluid from the abdomen) can be diagnostic, allowing for analysis of the fluid to check for infection or malignancy.

2. Liver Function Monitoring: Regular monitoring of liver function tests, including bilirubin levels, liver enzymes, and coagulation profiles, is crucial. If liver function deteriorates, further interventions may be necessary.

3. Infection Management: If there is any suspicion of infection, starting broad-spectrum antibiotics may be warranted while awaiting culture results. This is particularly important given her symptoms of fever and weakness.

4. Supportive Care: Ensuring that she receives adequate nutrition and hydration is vital. If she is unable to eat or drink adequately, consider discussing enteral feeding options with her healthcare team.

5. Consultation with Specialists: Engaging a hepatologist (liver specialist) and possibly an infectious disease specialist may provide additional insights into her management. They can help tailor treatment based on her specific needs and conditions.

6. Family Support: It’s important to maintain open communication with her healthcare team. They can provide updates on her condition and involve you in decision-making processes regarding her care.

In conclusion, your mother’s situation is complex, and it requires a multidisciplinary approach to address the various factors contributing to her current state. I encourage you to stay engaged with her medical team and advocate for her needs as they arise. I hope for her swift recovery and improved quality of life.

Best wishes,
Doctor Q&A Teams

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