14:25 -- I spent the morning at the hospital while Phoo took care of Meaghan; he's there now while I wait for Meaghan to finish napping. As soon as I arrived, Nurse S. told me that Dr. D. issued several new orders: first, an ultrasound by tomorrow morning of Max' liver, spleen and abdomen; second, a clotting study to determine if he needs FFP or other blood-related products; third, a Vitamin K shot. While his diapers revealed no fresh blood overnight, this morning he had fresh blood both in his stool and in the residual from his 05:00 feeding. Not good, especially after Dr. D. switched him from milk to Nutramigen, and from regular platelets to special platelets. Hence the ultrasound to see what's going on.
What Dr. D. fears is that Max may have portal hypertension, ("PH"), which is an increase in the blood pressure within a system of veins called the portal venous system. Normally, the veins come from the stomach, intestine, spleen and pancreas, merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked, it is hard for the blood to flow causing high pressure in the portal system. When the pressure becomes too high, the blood backs up and finds other ways to flow back to the heart, where it is pumped to the lungs, where it gets rid of waste products and picks up oxygen. The blood can travel to the veins in the esophagus, in the skin of the abdomen, and the veins of the rectum and anus to get around the blockages in the liver. The most common cause of portal hypertension is cirrhosis. Cirrhosis results from scarring of a liver injury caused by hepatitis, alcohol abuse or other causes of liver damage.
Obviously Max hasn't had time to acquire his father's love of single-malt scotch, so we're forced to bring Max' hepatitis back to the front burner. Dr. Dr. says it's too premature to travel down the PH road; we have to wait for the ultrasound to be performed, then wait for the results, then wait for Dr. D. and his consulting GI doctors to interpret the results. Because I'm a masochist, I asked what the long term prognosis is for PH and Dr. D. reluctantly told me, "liver transplant." I was sorry I asked. He said the next few days would be "rough" not for Max physically but for us emotionally. No $h|+.
The positive news is that Max' blood gas results are consistently "good" although I'm hesitant to say anything, lest I jinx his progress.
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