cirrosis of the liver

[buterfl]

how do you relieve swelling in the abdomin?

[California_Mama_Bear]

My daughter went to the ER twice recently due to severe abdominal pain and an onset of swelling; so I've been researching ascites in depth.  She is on spironolactone AND lasix, as well as prescription potassium - it's important to balance the potassium levels when taking diuretics, and cramping has been a sign of lowered potassium levels for her.  Ascites is VERY serious sign that the liver damage has progressed to a point where the liver can no longer compensate for the damage, and it's ability to function is failing; in addition, a bacterial infection in the retained fluid is an ever-present threat; if you develop a fever, seek medical help immediately.  Below is what I have found so far from various internet sources.

The most common clinical and quality-of-life indication for a liver transplant is ascites, or fluid in the belly due to liver failure. In the early stage of this problem, ascites may be controlled with medicines (diuretics) to increase urine output and with dietary modifications (limiting salt intake).  Ascites (fluid retention in the stomach) is a common complication of the de-compensated cirrhotic stage of diseases. The main underlying causes are portal vein hypertension, low serum albumin level, and lymph over-formation in the liver and spleen. This in turn, causes leaks on the surface of the liver and the membrane of the stomach-cavity.

The long-term prognosis of ascites is dependent on three factors: the degree of reversibility, the control of the underlying liver disease, and the patient’s response to treatments.  If the underlying liver disease can be controlled by effective treatment, then the ascites can be reversed quickly, and the fluid can be released.  With time, the patient can eventually restore their liver functions to the compensated level.  However, if the patient develops other complications, such as the deterioration of kidney functions and spontaneous bacterial infections ( SBP ) in the stomach cavity (peritonitis), the prognosis will worsen.  Therefore, ascites is a SERIOUS condition that requires IMMEDIATE care and active treatment as soon as it is found.

To treat ascites, first important step is the restriction of salt intake.  Generally, salt intake should not exceed 2 grams per day for a patient with ascites, and in persistent and severe cases, salt should be completely eliminated from the diet.  Because most prepared foods from supermarkets contain salt or sodium, it is important to read the label carefully.  
In conventional western medicine, a diuretic medication is usually used.  ( The combination of spironolactone and lasix works better than either medication when used alone.  http://www.medhelp.org/posts/Liver-Transplant/starting-to-swell-again-ankle/show/937865 )  Sometimes, the rate of the fluid release can become too high and cause a decrease in blood volume. This can adversely affect cardiovascular functions and to avoid this, the diuretic dose should be calculated carefully while the patient is monitored closely. Fluid restriction is generally NOT necessary UNLESS the serum sodium level becomes too low. Other treatment options for ascites include active draining of the fluid ( paracentesis ) and evaluation for a liver transplant.

[KjFlicka]

If you are referring to ascites, then a low sodium diet (less than 1.5g/day), low fluid intake (less than 48 fl oz/day) along with water pills like lasix and aldactone are usually a common treatment. They even drain the fluid in the hospital with a large needle if need be. Obviously the first treatment is preferred, though they often do the second at least once to test the fluid for infection.