July 27, 2024 - Jaundice Eyes
Saturday after my first week of work at my new job. It was going to be a day filled with relaxation and family time. The entire week of work was absolutely brutal! Brutal because at this point, I was having severe back pain, extreme bloating and nausea/vomiting. By the end of the week, I could barely walk due to my back pain, I couldn’t keep anything down (even water) and I could barely drag myself out of bed.
Keep in mind, I had stopped taking the medication used to treat my endometriosis, that I suspected was making me sick, on July 21, 2024. I was doing everything I possibly could to feel better. I was treating my nausea/vomiting with anti nausea meds, taking laxatives for my bloating and staying super hydrated but nothing was working! One full week without taking the medication and I only felt worse. Did the medication need more time to leave my system? Was I now just experiencing all the symptoms of my endometriosis returning at extreme levels? Or could it be something entirely different (after all my mom was doing major research on this medication and found that it could cause major organ damage 😳)?
That morning, I woke up and attempted to get my day started, but something was seriously wrong! Not only was I still having every single symptom I had all week x10, but I had YELLOW EYES!! What the heck was wrong with me?!!
I woke my mom up (she had been staying with us while she found a place of her own in Spokane) and we instantly made an appointment with urgent care. My appointment wasn’t until 3 p.m. but it couldn’t come fast enough! Once I arrived at urgent care, they attempted a urinalysis, but I could not urinate after multiple attempts. They finally concluded, that due to the complexity/nature of my complaints and their findings during the exam, that I go to the ER for a higher level of care. Final urgent care findings were:
Temp: 97.8, Pulse: 114, Resp: 20, O2: 90%, BP: 132/85
Abdominal distention, abdominal pain and constipation.
Difficulty urinating.
Conjunctiva jaundice bilaterally (yellow eyes)
We arrived at the ER shortly after leaving Urgent Care, about 4 p.m. and my vitals remained relatively unchanged and my initial labs were as follows:
Temp: 97.3, Pulse: 97, Resp: 13, O2: 95%, BP: 115/69
White Blood Cells – 17.19 (Normal Range 4-11)
Red Blood Cells – 3.08 (Normal Range 4.2-5.4)
Hemoglobin – 9.1 (Normal Range 12-15.5)
Hematocrit – 27.8 (Normal Range 36-48)
RDW-CV – 26.3 (Normal Range 11.5-14.5)
Creatinine – 4.45 (Normal Range 0.6-1.1) 😳
Bilirubin – 11.6 (Normal Range 0.1-1.2) 😳
AST – 224 (Normal Range 8-33) 😳
Alkaline Phosphatase – 159 (Normal Range 30-130)
Ethanol - 0
Tylenol - Detectable at 7
Initial observation determined it was necessary that I needed ongoing evaluation risk stratification of acute liver disfunction and potential for sudden decompensation (rapid and significant decline in my physical health). But what do all these lab results mean? They determined the following:
Leukocytosis (high white blood cell count) – suspected to be reactive to me being so sick.
Anemia and Coagulopathic consistent with liver disfunction (red blood cells, hemoglobin, hematocrit and RDW-CV)
Volume overloaded (fluid retention)
Hyponatremia (due to fluid retention causing sodium levels in the blood to be too low)
Hypokalemia (potassium levels in the blood are too low)
Prolonged QTc (time it takes for the heart’s ventricles to depolarize and repolarize)
Acute Renal Failure (consistent with creatinine being too high)
Oliguric (urine retention with 40 mL of urine in my bladder)
After initial testing and consultation with GI and the intensivist, it was recommended that they contact Swedish Medical Center in Seattle for transport and order repeat labs and CT abdomen/pelvis. I still had no idea exactly what was wrong with me but I knew it wasn’t good if they were going to send me to Seattle. I was terrified, I went into shock and my mind went blank from this moment forward.
My CT results came back as:
Diffuse increased hepatic echogenicity probably reflecting steatosis. Findings can be seen with chronic portal vein occlusion and cavernous transformation.
Steatosis (fatty liver disease) can be a sign of metabolic conditions like obesity, diabetes and high cholesterol. It can range from mild, where it may not cause any noticeable problems, to severe, where it can lead to inflammation and scarring (cirrhosis).
Chronic portal vein occlusion and cavernous transformation is a condition where the main portal vein, which carries blood from the digestive system to the liver, is blocked for an extended time. Long term complications of portal vein thrombosis factors including blood clotting disorders, inflammation, infections or tumors (all most commonly asymptomatic) can lead to:
Splenomegaly (enlarged spleen due to increased blood flow)
Varices (enlarged veins in the esophagus and stomach that can rupture and bleed, leading to gastrointestinal bleeding)
Ascites (fluid buildup in the abdomen)
Portal biliopathy (bile duct obstruction leading to jaundice and other complications)
All of this was started to make sense and my symptoms and other ailments I have been dealing with for several years all matched up with the findings in my test results. Anemia ✔️ Varices (I’ve had GERDS since my early 20s) ✔️Ascites (what I thought was bloating) ✔️ Portal biliopathy (gallbladder removal?) ✔️But Acute Renal Failure and Liver Disfunction?!
During their chart review, my most recent liver function tests from 3 months ago (the labs I had taken to even be approved to take the medication) showed a notable AST of 77 (remember Normal Range 8-33), otherwise unremarkable. So again, liver disfunction?!
My final diagnosis was:
Acute liver failure without hepatic coma
Hyponatremia
Hepatorenal syndrome
Coagulopathy
They were treating me for sepsis due to my high white blood cell count and were preparing me for transport to Seattle for a full liver transplant work up!
As of 9:15 p.m. I had been accepted to Swedish hepatology in Seattle but they did not have a bed available that night nor did they expect to have one available the next day, so I was added to the waitlist. In the meantime, I was admitted to a medical floor to wait.
I was given a MELD score (used to assess the severity of liver disease and prioritize patients for liver transplantation) of 36 (range from 6 to 40) and a 52.6% estimated 3 month mortality 😓😳
