Brief Answer:
Yes pain can be seen in few patients though rare but it can be there.

Detailed Answer:
Hello,
Thank you for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concern.

As per your query

Cirrhosis is a complication of many liver diseases characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis do so because they injure and kill liver cells, after which the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue.These new forming cells are pushing the scar tissue hence pain can be caused.

Usually cirrhosis is not painful in any stage yet in some case due to excess scarring pain can be there.In medical science there is no golden rule.Its the patient who decides the rule and not the doctor.If you are feeling pain then yes it can be due to cirrhosis and your doctor should rule out all other possiblities initially to find the exact cause.
As previously discussed, when cirrhosis is present, liver cells cannot function normally either because they are damaged or because they have lost their normal relationship with the blood. In addition, some of the blood in the portal vein bypasses the liver through other veins. The result of these abnormalities is that toxic substances cannot be removed by the liver cells, and, instead, the toxic substances accumulate in the blood.When the toxic substances accumulate sufficiently in the blood, the function of the brain is impaired, a condition called hepatic encephalopathy. In your case there may be a possibility that toxins produced are stimulating your brain falsely giving a sensation of pain.
Advice
please keep a track of levels of ammonia in your blood and report me.

As your gall bladder is already removed so it cannot be due to cholecystitis.

Hope i answered your query well.
Follow ups are welcome.
Regards

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Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,

The Golden rule of medicine is that there is no rule. When the patient is complaining of pain then treating doctor should consider it seriously. Cirrhosis usually doesn't cause pain but there are a number of documented cases of cirrhosis who suffer from extreme pain. Even a number of trials have also been performed to find out the most effective way to control pain.

Pain management in patients with cirrhosis is difficult and few prospective studies have offered an evidence-based approach. In patients with end-stage liver disease (YOUR CASE) adverse events from analgesics are frequent, potentially fatal, and often avoidable. Severe complications from analgesia in these patients include hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal bleeding, which can result in substantial morbidity and even death.

In general, acetaminophen at reduced dosing is a safe option.

In patients with cirrhosis, nonsteroidal anti-inflammatory drugs should be avoided to avert renal failure, and opiates should be avoided or used sparingly, with low and infrequent dosing, to prevent encephalopathy.

The pharmacokinetics of analgesic medications rely heavily on liver and renal function. The ability to clear drug metabolites decreases with liver dysfunction, resulting in altered parent drug or metabolite bioavailability and increased toxicity in cirrhotic patients.

Thus, if such drugs are administered to cirrhotic patients, the dose should be reduced and/or the drug used less frequently. Cirrhotic patients often have low serum protein and albumin concentrations. If a drug is highly protein bound, a low albumin level can result in increased levels of free drug and consequent increased adverse effects and toxicity. FDA may recommend limiting acetaminophen to a maximum daily dosage of 2.6 g.

This was all theoretical part and is difficult for laypersons to understand.

So, for you, take Home message is-

1) In general, for long-term acetaminophen use in cirrhotic patients is for reduced dosing at 2 to 3 g/d.

2) For short-term use or 1-time dosing, 3 to 4 g/d appears to be safe; however, with the new FDA recommendations, a maximum dosage of 2 to 3 g/d is recommended.

3) NSAIDs and opioids may be used at reduced doses in patients with chronic liver disease WITHOUT cirrhosis.

4) Patients with cirrhosis have fewer analgesic options. NSAIDs should be avoided in those with both compensated and decompensated cirrhosis, primarily because of the risk of acute renal failure due to prostaglandin inhibition. Opiates should be avoided or used sparingly at low and infrequent doses because of the risk of precipitating hepatic encephalopathy.

Please discus these options with your Gastroenterologist. Despite repeated complaints, just saying that cirrhosis does not cause pain, is definitely not justified.

Hope you got your answers.
Follow up are welcome.

Regards.

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