Page 14 - Time to DeLiver: Getting a Grip on HE report 2015

CASE STUDY

Charlie is a 47-year-old hotel owner.

Prior to receiving a diagnosis for primary biliary
cirrhosis (an autoimmune disease), Charlie began
exhibiting behavioural changes that his wife, Angie, was
concerned may be the initial symptoms of dementia.
He was increasingly impatient and quite easily confused
and often complained of feeling tired and lethargic.

Charlie became increasingly difficult to live with as he was argumentative, unwilling
to talk to the hotel guests and struggled with daily activities and processes, such as
the hotel’s reservation system. Following a diagnosis from his GP of liver problems,
Charlie was referred to see a hospital consultant in a specialist liver unit. The initial
diagnosis did not refer to hepatic encephalopathy, despite his GP noting his dementia-like
symptoms on his medical records. While waiting for this referral appointment, Charlie’s
symptoms worsened and he became increasingly aggressive and confused. Through
internet research, Angie found out about hepatic encephalopathy, however Charlie’s GP
maintained that his symptoms were a reaction to the diagnosis of liver problems.

Eventually Charlie was diagnosed with primary biliary cirrhosis, prescribed therapy
for his severe hepatic encephalopathy and placed on the liver transplant waiting list.
Unfortunately whilst awaiting a transplant, Charlie suffered a fall and was admitted to
hospital where he became extremely agitated and upset forcing the hospital staff to
call security and eventually the police. As a result of this incident, Charlie was
summoned to appear in court and despite supportive letters from his liver specialist,
the Community Health Council and patient associations the case was not dropped
until after Charlie’s transplant.

Fortunately, Charlie received a liver transplant nine months ago and although his
symptoms worsened immediately after, his quality of life has since significantly improved.
However, both Charlie and Angie have noticed that he still gets confused and sometimes
struggles with daily tasks and communication.

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