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

### input:
I have had a liver transplant due to chirrosis and my liver dr. says everything is functioning fine. My current problem is with ammonia and the high levels in my blood that is being treated by injestion of 60 mg of laculose x4/day. Talk about no life outside a bathroom! What could be causing the elevated ammonia levels beside my liver?

### output:

Hello, Welcome to Chat Doctor. I read carefully your query and I understand your concern. You had a transplant liver, ammonia is the product of bacterial activity on protein in intestine, and then it is absorbed and transported to the liver and the liver degrades into end products and waste products, having a liver disease cause the high level of ammonium in blood. The component of the production of ammonia are diet protein and bacterial flora of the intestine, so you should reduce the protein intake through your diet, and specially you should avoid the intake of cheese, peanut butter, onion, mayonnaise, ketchup etc. The other component is the bacterial flora in intestine, for this you can take Lactulose that is a laxative that alters bacterial flora and makes fewer organisms available to produce ammonium, and you take it, you can use with or without the Lactulose antibiotics e.g. Noticing take from oral rout induce the reduction of ammonia production by the intestinal bacterial flora. Except the diet and medication to keep reduced the ammonium blood level you should take a healthy diet and have a healthy lifestyle to keep healthy the liver and this include a healthy weigh that avoid complications e.g. high blood pressure, so you should: eat five serving of fruits and vegetable every day; eat lean meat; eat whole grain breads; increase the fiber in your diet; Chat Doctor. 