### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a ED R.N. who had a male friend that was adopted, had no remainning family, that developed cirrhosis of the liver, then cancer of the liver and he also had diabetes. There was no one to help Billy in any way. Since we had been friends in a small rural community for 64yrs. and there was no one to care for Billy, I told him I would help him as much as I could. When I first went to see Billy, there was a little 25yr. boy that the county had appointed to feed the dogs for Billy. He in the space of 6 weeks tricked Billy into signing over his farm to him. Billy really wanted the farm to go to his Mother s distant cousin s 3 daughters, who were just entering or finishing college. He tried to get the boy to tear up the paper where he had signed his farm over to him. Billy ask me on his death bed to please see that the farm went to the 3myoung girls of his distatn cousins. I refused to take anything from Billy, no gifts,or anything! Wehad been friends since we started kindergarten together. He was so confused between his elevated ammonia levels, his out of controll diabetes that he could not rationally make decisions regarding his farm. He was so confused and the boy that tricked him into signing his farm over to him, took advantage of Billy and told me himself that he knew Billy was confused because he poured talcum powder on the outside of his shirt and pants when they were leaving Billy s house. I called the distant cousin to inform him of Bily s problem. I need a list of the mental changes that Billy was causing Billy to be be so confused and totally unable to make sound decisions in regard to himself or his farm. I was his designated Health Care Power of attorney (legally). I need a list of mental changes that occurr during someone last 3 months of living.

### output:

Welcome at Chat Doctor I have gone through your query and being your physician I completely understand your health concerns...... The confusion which you're talking about is actually a Hepatic encephalopathy secondary to cirrhosis of liver.  Raised ammonia levels points towards it. Mostly constipation and fever are precipitating factors.... He needs proper management of chronic liver disease to control encephalopathy.  He may need keen enema along with spy lactulose.  Furthermore, he may require antibiotics too. He should meet hepatologist for it.  As far as liver cancer is concerned, it really needs investigation to look for its spread and stage. After then any treatment can be offered.  Meet your physician without further delayRegards Chat Doctor. 