@jenniferhunter I do the same, Jennifer, and did much research but never came across liver problems! My local doctor is highly regarded but he missed the boat on me. The doctor I started with thought I had Alzheimer's after I had one HE episode! She was history as soon as I could find a different doctor.
I was a mystery to my PCP, and my hematologist who I was seeing because my platelet count was low and continually getting lower. It was finally the neurologist I was sent to who hit on it being my liver. Interestingly, my sister mentioned my symptoms to her niece who is a nurse and her niece said it sounded like liver! My sister never wants to interfere so she never told me that until afterward.

@jenniferhunter That's really terrible about your care with the first doctor, but please be assured that not all spine doctors are that callous. My brother-in-law had spine surgery last year in Boston, done by a wonderful doctor who was caring and did a great job.
JK