Archive for the Patient Category

Hepatic Encephalopathy (confusion) – UMich

When to get Help

Only mild symptoms of encephalopathy should be managed at home.

Go to the nearest emergency department, or have someone call 911 if you:

  • have severe confusion or sleepiness
  • can’t speak, walk properly, or follow directions
  • have a fever
  • have severe nausea and vomiting

What is Hepatic Encephalopathy?

When the liver’s been damaged by cirrhosis, it might not be able to get rid of toxins such as ammonia. As a result, ammonia and other toxins may build up in your bloodstream and brain. This causes a problem called hepatic encephalopathy (pronounced “en-sef-a-lop-a-thee”). You may hear your healthcare team call it HE for short. When you have HE, toxins build up which can cause confusion and other symptoms.

Causes

Encephalopathy is most likely to occur in people who have high pressure in their portal vein (portal hypertension). It may also occur in people who have severe acute liver damage (liver damage that happens suddenly) but no portal hypertension.

Also, a procedure called TIPS that is used to lower portal hypertension by shunting blood flow around the liver can increase your risk for encephalopathy.

Other things that might contribute to encephalopathy include:

  • abnormal levels of electrolytes
  • constipation
  • not getting enough fluids to drink or loosing fluids too quickly (dehydration)
  • internal bleeding
  • infection
  • medicines like pain killers and sleeping pills

Symptoms

Symptoms of encephalopathy might include:

  • coma
  • disorientation (not remembering where you are or what’s happening)
  • difficulty remembering the right words to say
  • drowsiness
  • hand “flapping”
  • sleep pattern changes
  • feeling irritable
  • trouble concentrating
  • poor short-term memory
  • having tremors

Treatment

Your Support Network

Share what you learn about hepatic encephalopathy with your caregivers, friends, and loved ones. This is important because having encephalopathy can make it hard for you to care for yourself at times, and you may need extra support. Your support network can help you watch for emergency warning signs. For example, if they notice you’re really confused or have trouble waking up, they can call 911 or take you to the nearest emergency department.

Lactulose

In most situations, encephalopathy is treated with a medicine called lactulose. Lactulose is a laxative syrup that makes your bowels move more often and also makes your bowel movements more acidic. This helps your body to get rid of toxins like ammonia from your body.

If you are taking lactulose, you should take enough so that you are having 2 or 3 soft bowel movements each day. If you take too much you will get diarrhea, but if you don’t take enough you will develop encephalopathy symptoms. You should increase the amount you are taking if you are not having enough bowel movements. Finding the right balance for you is the key. You can get more information about lactulose (including potential side effects) from your pharmacist.

Rifaximin (Zaxine, Xifaxan)

Another treatment for encephalopathy is rifaximin. Rifaximin is an antibiotic that stays in your digestive system and changes the bacteria in your gut so they make less toxins like ammonia. Rifaximin comes as a pill and is usually taken two times a day. You can take it with or without food. You can get more information about rifaximin (including potential side effects) from your pharmacist.

Self Care Tips:

If you are being treated for hepatic encephalopathy:

  • Avoid medicines that can make you sleepy
  • Record the number of bowel movements you have each day in a notebook or app on your phone
  • Take enough lactulose so you have 2 to 3 medium to large, soft bowel movements a day.
  • Don’t take more lactulose than you need because it may make you dehydrated.
  • If you develop a mild increase in your encephalopathy symptoms, take more lactulose (as long as you are not having diarrhea, fever, or signs of bleeding).

Let your healthcare provider know if you:

  • have trouble adjusting your dose of lactulose
  • feel tired, sleep more, or your sleep patterns change so you’re up at night and sleep during the day
  • have trouble concentrating or remembering things
  • have a change in your personality
  • notice shaking of your body (called a tremor) or are unsteady (feel like you may fall)

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

Varices (enlarged veins) – UMich

When to Get Help

Go to the nearest emergency department, or have someone call 911 if you:

  • are vomiting blood or something that looks like coffee grounds
  • have black or tar-like bowel movements

These are signs that varices may have begun to bleed. 

What are Varices?

When pressure in the portal vein gets too high, it can cause pressure to rise in other blood vessels. This can make the veins in your esophagus (food pipe), and stomach swell. These swollen veins are called varices. In some cases, these veins can get so swollen that they burst. This causes bleeding inside your esophagus and stomach, which is dangerous.

Symptoms

The problem with varices, is that they don’t cause symptoms until they burst open and bleed. Many people have varices and don’t know that they do. Sometimes they’re found during an upper endoscopy (also known as gastroscopy).

The more severe the liver damage and the larger the varices, the greater risk you have for bleeding varices. Bleeding varices can be a life-threatening emergency. After varices have bled once, there’s a high risk of bleeding again.

Treatment

Upper Endoscopy (Gastroscopy)

Your healthcare team will look at the results of your blood and other tests to determine your risk of having varices. If you are at higher risk, your healthcare team may want you to have a procedure called an upper endoscopy (gastroscopy). An upper endoscopy involves inserting a tiny camera through your mouth to look down into your esophagus and into your stomach. If you have varices, they can be tied off with tiny rubber bands during the procedure (called banding).

If your first upper endoscopy didn’t find any varices, you will likely have another one again in 1 to 3 years. If  you have varices, you may need more frequent upper endoscopies. You’ll also need to have an upper endoscopy more often if you’ve had bleeding varices.

Medication (nonselective beta-blockers)

Your healthcare team may also prescribe blood pressure medicine called nonselective beta-blockers to help lower the risk of bleeding from varices. If you take this medicine, you’ll need to check your blood pressure and pulse regularly. If you feel dizzy, lightheaded, or fall, let your doctor or nurse know.

TIPS (a shunt used to decrease pressure in the portal vein)

In more severe cases, an TIPS procedure may be required to stop or prevent future bleeding. This is a procedure done by an interventional radiologist in a specialized hospital.

Self Care Tips:

  • Check the colour of your bowel movements (stool) for signs of bleeding. If there’s blood in your stool, it may be black or look like tar
  • Attend upper endoscopy appointments when recommended by your healthcare provider

If you take blood pressure medicine:

  • check your blood pressure and pulse 2 to 3 times a week. Rest for at least 5 minutes before you check these measurements
  • Record your measurements in a notebook or app on your phone

Let your healthcare provider know if:

  • your pulse is less than 50 beats per minute
  • the first (or top) number of your blood pressure is lower than 90
  • you are dizzy, lightheaded, or fall

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

Ascites (fluid in the abdomen) – UMich

When to Get Help

Contact your healthcare provider right away or go to the emergency department if you have:

  • trouble breathing
  • new or sharp pain in your belly that doesn’t go away
  • a fever
  • nausea and vomiting

What is Ascites?

The most common major complication of cirrhosis is ascites (pronounced “a-sigh-tees”). When pressure in the portal vein gets too high (called portal hypertension), fluid leaks out and builds up. This can make your abdomen enlarge like a balloon filled with water. Ascites might be diagnosed with a physical exam. You may need other tests like an ultrasound (to look for fluid) or paracentesis (to take a sample of the fluid for testing).

Ascites can be very uncomfortable. Eating can be a problem because you have less room for food. Even breathing can be a problem, especially when you’re lying down. It can also lead to fluid buildup in the space around your lungs (called pleural effusion or hepatic hydrothorax), or abdominal hernias – especially umbilical hernias (when tissue from inside the abdomen bulges out through a weak spot in the navel or belly button).

The most dangerous problem associated with ascites is an infection called spontaneous bacterial peritonitis (SBP), which can be life-threatening. Some symptoms of SBP are fever, abdominal pain, nausea and vomiting, or confusion. If you get spontaneous bacterial peritonitis (SBP), you will need antibiotics to treat it. After you recover, you will probably be prescribed another antibiotic to reduce your risk of getting SBP again.

Treatment

Treatment for ascites caused by cirrhosis can include more than one of the options listed below.

Low Sodium (Salt) Diet

Restricting sodium is an important part of ascites treatment. Too much sodium can make your body hold on to extra fluid. This fluid can pool in your belly, chest and legs. Eating foods with less sodium can help control ascites.

  • Aim to eat less than 2000 mg of sodium a day.
  • One teaspoon of salt has about 2300 mg of sodium.
  • All types of salt contain the same amount of sodium, including table salt, sea salt, and Himalayan salt.

Tips to reduce sodium:

  • At first, foods may taste bland. Over time, your taste buds get used to less salt.
  • Don’t add salt to your food while cooking or at the table.
  • Choose fresh, unprocessed, and homemade foods.
  • Eat less processed, packaged, or restaurant foods.
  • Limit condiments and sauces (ketchup, mustard, soy sauce, gravies, salad dressings).
  • Limit pickled foods, olives, chutneys, and dips.
  • To boost flavours, try adding spices, seasoning mixes with no salt added, lemon, lime, vinegar, fresh or dry herbs, garlic, or onions

Read food labels

Diuretic Medicine

Diuretic medicines such as furosemide and spironolactone can also help to get rid of the fluid that has built up in the abdomen (belly) and other parts of the body. If you have ascites, your doctor may prescribe a diuretic for you to take.

If you are taking diuretics, it is important to weigh yourself daily to monitor the effect of diuretics. One litre of ascites weighs about 2.2 pounds (1 kg). Gradual weight loss is a sign of decreasing ascites – this is expected and desired when diuretics are first started. Losing weight too quickly can be dangerous.

You should also have your blood work checked as recommended by your healthcare team because diuretics can effect your kidneys and electrolyte levels. Your dose of diuretics can be adjusted by your healthcare team if you are losing weight too quickly, having side effects, or they don’t seem to be working.

Let your healthcare team know if you are experiencing:

  • dizziness
  • a decrease in urination
  • confusion or sleepiness
  • have ongoing or worsening swelling in your abdomen (belly)
  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week

Paracentesis

Paracentesis is a procedure used to remove ascites fluid.

Sometimes paracentesis is used to take a sample of the fluid for determining why it’s building up. Paracentesis might also be used if you have cirrhosis and the following circumstances:

  • You have severe ascites. It’s causing extreme discomfort, abdominal pain, and difficulty breathing. A paracentesis treatment may relieve the discomfort before you begin treatment with one or more diuretics.
  • You haven’t responded to the standard ascites treatment of a low-salt diet and diuretic medicines, or your body is unable to tolerate diuretic medications. This is the case in less than 10% of people with ascites. In this situation, you may require paracentesis repeatedly.
  • Your doctor suspects the fluid is infected.

Other Treatments

Your healthcare team may recommend other treatment options. Options available to you will depend on lots of different factors like your age, other medical conditions and how sick your liver is. Some other treatment options might include:

Self Care Tips:

  • weigh yourself each morning before breakfast, before you drink anything or take medicine, and after you pee (urinate).
  • Keep track of your weight in a notebook or app on your phone. Most people will see changes in weight readings, even before they notice changes in how their abdomen looks or feels.
  • If you are taking diuretics (water pills), have your blood tests done regularly to check your kidneys and electrolytes as recommended by your health team.

Let your healthcare provider know if you:

  • feel dizzy
  • are not passing enough urine
  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week
  • have ongoing or worsening swelling in your abdomen (belly)
  • gain 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR gain 5 pounds (2.3 kg) in a week

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

Medication Safety – UMich

Most medicines are processed through the liver and kidneys. So, it’s important to think about safety when you are taking medicine, especially when you have liver or kidney disease.

Know the names of your medicines and what they are used for. Bring a list of them and the doses to appointments with your healthcare team. Without this information, it will be difficult and possibly even unsafe to make changes in your treatment.

Always take your medicine as prescribed and let your health care team know if you are taking over-the-counter or herbal medicines. If you are not sure if something is safe, please ask a member of your healthcare team, like your pharmacist.

Below you can find information for people with cirrhosis, on some common medications.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (or NSAIDs) are medicines used to treat pain. Some examples of NSAIDs are ibuprofen, Motrin, Advil, Naproxn and Aleve. You should avoid NSAIDs if you have cirrhosis, especially if you have problems with ascites or fluid build-up. They can cause serious problems with your kidneys and increase your risk of bleeding.

Acetaminophen (Tylenol®)

If you have cirrhosis, you may have been told not to take acetaminophen. But, you actually can as long as you keep the dose to less than 2000 milligrams a day and don’t drink alcohol. You can take up to 4 extra strength acetomentophen in a day, as long as they only have 500mg in each pill. You should always read the medicine label. If you follow these guidelines, acetaminophen is actually safer than most other pain medicines.

Opioids

Narcotics and opioids are usually used to treat pain. Some examples are codeine, morphine and fentanyl. Taking these medicines when you have cirrhosis is complicated, and can be dangerous, and it’s best to avoid them.

Sedatives

Benzodiazepines are a type of medicine used to treat anxiety. Some examples are Ativan or valium. They can make you feel really sleepy if you have cirrhosis. It’s best to avoid them or take them as little as possible. Even over-the-counter medicines like Benadryl, which is used for itching and allergies, or Gravol, for nausea, can cause too much sleepiness. If you need to take these medicines, try taking a lower dose for a limited period of time.

Cold and Flu Medications

Many over the counter medicines for colds and flus contain more than one drug. Some contain NSAIDs, which you shouldn’t take. Others have decongestants and antihistamines that can make you drowsy. Remember to read medication labels so you know what’s in them before you take them.

Herbal Medicines

The small amounts of herbs used in cooking don’t usually cause health problems. But, herbal medicines can be risky, because they contain more concentrated and larger amounts of herbs.

Milk thistle is a common herbal medicine that people with liver disease might be interested in. Studies haven’t proved that it helps the liver, but it’s generally considered safe, although it can have side effects like diarrhea and bloating.

Remember that just because something is “natural” doesn’t mean it’s safe. Most herbal medicines have not been studied in people with cirrhosis, and some have been found to be toxic for the liver.  Also, herbal medicines can interact with other medications you’re taking.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021

Alcohol – UMich

Go back to learning modules

Anyone with liver disease should NOT drink alcohol. 

Alcohol affects everyone. When a person has a drink, the alcohol is absorbed through the wall of the stomach and intestine into the bloodstream, where it is sent throughout the body. Alcohol affects the brain, heart, muscles and other tissues of the body.

Age, gender, body weight, and genetic factors can all affect the way alcohol is processed by the body. For example, women absorb more alcohol from each drink than men do and tend to be more susceptible to alcohol-related liver damage.

The liver filters and processes everything a person ingests, including alcohol. If the liver is damaged, even small amounts of alcohol can make things worse.

Finding it hard to avoid alcohol?

Cutting down or stopping drinking may be difficult at times. Most people do not cut down or give it up all at once. Just like going on a diet, it is not easy. That’s OK. If you don’t reach your goal the first time, try again. Get support from people who care about you and want to help. Don’t give up!

Drinking Diary 

To keep track of how much you drink, use a drinking diary. Record the number of drinks you have each day. At the end of the month, add up the number of drinks you had each week.

Change Plan

One way to make any kind of change in your behavior is to come up with a “change plan.” This exercise has you list the specific goals you would like to achieve, outline the steps and challenges you will meet in reaching those goals, and figure out ways to overcome those challenges.

Helpful Tips
  • Keep no alcohol, or only a small amount at home.
  • If you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink water or non-alcoholic drinks after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.
  • If you drink, pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.
  • You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.
  • Watch out for people, places, or times that make you want to drink, even if you do not want to.
  • Stay away from people who drink a lot and avoid bars where you used to go.
  • Plan ahead of time what you will do to avoid drinking when you are tempted.
  • Don’t drink when you are angry or upset or have a bad day. These are habits you need to break if you want to drink less.
  • What would you do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a movie, or go for a walk.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021

When to Go to Emergency – UMich

When to Get Help:

If you have cirrhosis and get any of the symptoms below, DO NOT DRIVE. Call 911 or get someone to take you to an emergency room immediately. Say you have cirrhosis, and describe what’s happening to you.

Cirrhosis ComplicationSymptoms
Bleeding Varices
Bleeding from varices (enlarged veins) in the esophagus (food pipe) or stomach bursting open
You vomit blood or something that looks like coffee grounds

You have black, tar-like bowel movements
Encephalopathy
Confusion or sleepiness from a buildup of toxins in the blood
You have a fever

You have severe confusion or sleepiness

You can’t speak, walk, or follow directions properly

You have severe nausea and vomiting
Infection in Ascites or Pleural Fluid
Infection in fluid buildup in the abdomen (belly) or around the lungs
You have new or sharp pain in your belly or chest that doesn’t go away

You have a fever

You have trouble breathing

You have severe nausea and vomiting
Jaundice
Yellowing of the eyes and skin
Your eyes and skin have suddenly turned yellow

Note: This section was adapted from content on MyHealth.Alberta.ca.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

What is Cirrhosis? UMich

There are many things that can cause damage to the liver, like too much alcohol or fat, and conditions related to genes and the immune system. When something damages the liver, scar tissue begins to form. This scarring is called fibrosis. When the entire liver is scarred, it shrinks and gets hard. This is called cirrhosis.

Any illness that damages the liver may lead to fibrosis and, eventually, cirrhosis.

A liver with cirrhosis can have a harder time getting all of it’s regular factory work done. This means it can have a trouble making important substances, like blood proteins. It also can have trouble storing what your body needs, like sugar and vitamins. It might not be able to remove all of the toxins and bacteria that your body doesn’t need. And, it can have trouble regulating things like blood clotting.

How is Cirrhosis Diagnosed?

If you suspect you have cirrhosis, make an appointment with your doctor or nurse practitioner.

They may examine you to look for signs of cirrhosis like red palms, small spider-like veins on your face or body and fluid buildup in your abdomen.

They might order blood tests. To learn more about tests related to cirrhosis, visit Lab Tests.

Usually a scan (like ultrasound, CT, or MRI) will be done to see what your liver looks like. Another type of scan that measures the amount of stiffness in your liver (as the liver gets scarred, it gets stiffer), may also be done.

Some people might be asked to have a liver biopsy, although this is not as common.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
Last reviewed March 15, 2021

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Dalia Abdellatif
Juan Abraldes
Franklin Adamson
Sandy Anderson
Marlis Atkins
Wayne Bai
Robert Bailey
Vince Bain
Jasmohan Bajaj
Neeja Bakshi
Heather Ball
Tanya Barber
Shannon Beaudoin
Dawn Belland
Annalisa Berzigotti
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Patty Bloom
Meredith Borman
Scott Bridges
Amanda Brisebois
Brian Buchanan
Doug Buchholtz
Kelly Burak
Denise Campbell-Scherer
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Ascites (fluid in the abdomen) Test

When to Get Help

Contact your healthcare provider right away or go to the emergency department if you have:

  • trouble breathing
  • new or sharp pain in your belly that doesn’t go away
  • a fever
  • nausea and vomiting

What is Ascites?

The most common major complication of cirrhosis is ascites (pronounced “a-sigh-tees”). When pressure in the portal vein gets too high (called portal hypertension), fluid leaks out and builds up. This can make your abdomen enlarge like a balloon filled with water. Ascites might be diagnosed with a physical exam. You may need other tests like an ultrasound (to look for fluid) or paracentesis (to take a sample of the fluid for testing).

Ascites can be very uncomfortable. Eating can be a problem because you have less room for food. Even breathing can be a problem, especially when you’re lying down. It can also lead to fluid buildup in the space around your lungs (called pleural effusion or hepatic hydrothorax), or abdominal hernias – especially umbilical hernias (when tissue from inside the abdomen bulges out through a weak spot in the navel or belly button).

The most dangerous problem associated with ascites is an infection called spontaneous bacterial peritonitis (SBP), which can be life-threatening. Some symptoms of SBP are fever, abdominal pain, nausea and vomiting, or confusion. If you get spontaneous bacterial peritonitis (SBP), you will need antibiotics to treat it. After you recover, you will probably be prescribed another antibiotic to prevent getting SBP again.

Treatment

Treatment for ascites caused by cirrhosis can include more than one of the options listed below.

Low Sodium (Salt) Diet

Restricting sodium is an important part of ascites treatment. Too much sodium can make your body hold on to extra fluid. This fluid can pool in your belly, chest and legs. Eating foods with less sodium can help control ascites.

  • Aim to eat less than 2000 mg of sodium a day.
  • One teaspoon of salt has about 2300 mg of sodium.
  • All types of salt contain the same amount of sodium, including table salt, sea salt, and Himalayan salt.

Tips to reduce sodium:

  • At first, foods may taste bland. Over time, your taste buds get used to less salt.
  • Don’t add salt to your food while cooking or at the table.
  • Choose fresh, unprocessed, and homemade foods.
  • Eat less processed, packaged, or restaurant foods.
  • Limit condiments and sauces (ketchup, mustard, soy sauce, gravies, salad dressings).
  • Limit pickled foods, olives, chutneys, and dips.
  • To boost flavours, try adding spices, seasoning mixes with no salt added, lemon, lime, vinegar, fresh or dry herbs, garlic, or onions

Read food labels

 

Diuretic Medicine

Diuretic medicines such as furosemide and spironolactone can also help to get rid of the fluid that has built up in the abdomen (belly) and other parts of the body. If you have ascites, your doctor may prescribe a diuretic for you to take.

If you are taking diuretics, it is important to weigh yourself daily to monitor the effect of diuretics. One litre of ascites weighs about 2.2 pounds (1 kg). Gradual weight loss is a sign of decreasing ascites – this is expected and desired when diuretics are first started. Losing weight too quickly can be dangerous.

You should also have your blood work checked as recommended by your healthcare team because diuretics can effect your kidneys and electrolyte levels. Your dose of diuretics can be adjusted by your healthcare team if you are losing weight too quickly, having side effects, or they don’t seem to be working.

Let your healthcare team know if you are experiencing:

  • dizziness
  • a decrease in urination
  • confusion or sleepiness
  • have ongoing or worsening swelling in your abdomen (belly)
  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week

Paracentesis

Paracentesis is a procedure used to remove ascites fluid.

Sometimes paracentesis is used to take a sample of the fluid for determining why it’s building up. Paracentesis might also be used if you have cirrhosis and the following circumstances:

  • You have severe ascites. It’s causing extreme discomfort, abdominal pain, and difficulty breathing. A paracentesis treatment may relieve the discomfort before you begin treatment with one or more diuretics.
  • You haven’t responded to the standard ascites treatment of a low-salt diet and diuretic medicines, or your body is unable to tolerate diuretic medications. This is the case in less than 10% of people with ascites. In this situation, you may require paracentesis repeatedly.
  • Your doctor suspects the fluid is infected.

Other Treatments

Your healthcare team may recommend other treatment options. Options available to you will depend on lots of different factors like your age, other medical conditions and how sick your liver is. Some other treatment options might include:

Self Care Tips:

  • weigh yourself each morning before breakfast, before you drink anything or take medicine, and after you pee (urinate).
  • Keep track of your weight in a notebook or app on your phone. Most people will see changes in weight readings, even before they notice changes in how their abdomen looks or feels.
  • If you are taking diuretics (water pills), have your blood tests done regularly to check your kidneys and electrolytes as recommended by your health team.

Let your healthcare provider know if you:

  • feel dizzy
  • are not passing enough urine
  • are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week
  • have ongoing or worsening swelling in your abdomen (belly)
  • gain 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR gain 5 pounds (2.3 kg) in a week

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021