Fatigue and Abdominal Bloating Could Signal Progression of Liver Disease – A Cautionary Case Study
A 45-year-old male patient with a known history of chronic hepatitis B for the past decade recently sought medical attention due to persistent fatigue and abdominal bloating. Over the years, he had been hospitalized multiple times at other facilities for complications including ascites. Following a recent episode of upper gastrointestinal bleeding and subsequent endoscopic treatment, he visited our hospital for further evaluation.
Diagnostic imaging, including a CT scan, revealed significant liver damage consistent with decompensated cirrhosis. The scan showed a shrunken liver with irregular margins, widened hepatic fissures, and fluid accumulation around the liver and spleen. Additionally, splenomegaly and dilated blood vessels near the esophagus were noted. With these findings, a diagnosis of advanced liver cirrhosis was confirmed.
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Initial Assessment and Presentation
The patient had a complex medical background. He had been managing type 2 diabetes for six years, with peak blood glucose levels reaching 17.0 mmol/L. Through insulin therapy, his blood sugar levels were well-controlled. However, over the past three months, he experienced unexplained weight loss of about 10 kg, along with worsening fatigue, dizziness, and disturbed sleep patterns.
His symptoms pointed toward progressive liver dysfunction. Combined with his long-standing hepatitis B infection and prior episodes of ascites and esophageal varices, it became clear that his condition had progressed to decompensated cirrhosis.
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Treatment Plan and Management
Upon admission, a comprehensive treatment strategy was implemented:
- Antiviral therapy using entecavir dispersible tablets and daclatasvir hydrochloride tablets was initiated to suppress viral replication.
- Diuretics such as spironolactone and furosemide were prescribed to manage fluid retention and reduce ascites.
- Intravenous albumin and potassium supplements were administered to maintain electrolyte balance and support circulatory stability.
- Hepatoprotective agents like vitamin C and compound glycyrrhizin tablets were used to aid liver function.
The patient responded positively within days of starting treatment, with noticeable reduction in abdominal distension and improvement in energy levels.
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Recovery and Discharge Outcome
After one week of inpatient care, the patient's condition stabilized. His blood tests returned to normal ranges, and his overall well-being improved significantly. He was discharged with instructions to continue his antiviral medications and schedule a follow-up visit in one month.
Patients with cirrhosis must adhere strictly to their medication regimen even after symptoms subside, as interrupting treatment can lead to disease flare-ups or complications.
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Key Recommendations for Long-Term Care
To prevent further deterioration and reduce the risk of complications, the following lifestyle modifications were emphasized:
1. Continue prescribed antiviral therapy without interruption.
2. Adopt a nutrient-rich diet high in protein and vitamins while avoiding alcohol and spicy foods.
3. Practice good hygiene and avoid sharing personal items to prevent transmission of hepatitis B.
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Clinical Insights
This case highlights the importance of long-term monitoring for individuals with chronic hepatitis B. Without timely intervention, the condition can progress silently to cirrhosis, leading to life-threatening complications such as portal hypertension, ascites, and hepatic encephalopathy.
Regular check-ups and early detection are crucial for maintaining quality of life and preventing irreversible liver damage. Patients should be educated on recognizing early warning signs like fatigue, bloating, and weight changes, which may signal worsening liver function.
By combining effective antiviral therapy with lifestyle management and ongoing surveillance, patients can better manage their condition and potentially slow disease progression.