This article is for you if you are a caregiver or a family member of someone who has alcoholic cirrhosis of the liver with ascites. You may have many questions and concerns about this condition and how to provide the best care for your loved one. This article will address some of your questions and provide helpful information and advice.
Alcoholic cirrhosis of the liver with ascites is a severe and complex condition that affects many people worldwide. It is caused by chronic alcohol abuse, which damages the liver and impairs its function. The liver is a vital organ that helps your body digest food, fight infections, and eliminate toxins. When the liver is damaged, it can lead to many problems, such as fluid accumulation in the abdomen, yellowing of the skin and eyes, bleeding, confusion, and more. These problems can make your loved one very ill and uncomfortable.
Alcoholic cirrhosis of the liver with ascites is not a curable condition, but it can be managed with appropriate treatment and care. Treatment and care aim to improve your loved one’s symptoms, prevent complications, and enhance their quality of life. This is called palliative care. Palliative care is a type of care that focuses on relieving suffering and providing comfort and support to patients and their families. Palliative care can help your loved one live longer and better, even if they have a severe illness.
This article explains alcoholic cirrhosis of the liver with ascites and how to care for your loved one. It is divided into several sections, each covering a different topic. We hope this article will help you understand and cope with this condition and provide the best care possible for your loved one.
What is Alcoholic Cirrhosis of the Liver with Ascites?
If you are caring for someone who has alcoholic cirrhosis of the liver with ascites, you may wonder what this condition means and how it affects your loved one’s health. In this section, we will explain some basic facts about this condition and answer some frequent questions you may have.
What is cirrhosis, and how does it affect the liver function?
Cirrhosis is when the liver, a vital organ that performs many essential bodily functions, becomes scarred and damaged over time. The liver helps to filter toxins from the blood, break down food and nutrients, produce bile and blood proteins, store energy, and fight infections. When the liver is healthy, it can regenerate and repair itself after an injury. However, when the liver is exposed to chronic or repeated injury, such as from excessive alcohol consumption, it cannot heal properly, and scar tissue replaces the healthy tissue. This scar tissue blocks the normal blood flow through the liver and reduces its ability to function. As cirrhosis progresses, the liver becomes smaller, harder, and less effective.
What is ascites, and how is it related to cirrhosis?
Ascites is a condition in which excess fluid accumulates in the abdomen, causing it to swell and become distended. Ascites is one of the most common and severe complications of cirrhosis. Several factors contribute to the development of ascites in people with cirrhosis:
Portal hypertension. This is a condition in which the pressure in the portal vein, the main blood vessel that carries blood from the digestive organs to the liver, becomes abnormally high due to the scarred and narrowed liver. This causes the blood to back up and divert to other smaller veins that are not equipped to handle the increased volume and pressure. Some of these veins are in the abdomen, where fluid leaks into the peritoneal cavity, the space between the two layers of tissue that line the abdomen and cover the organs.
Low albumin. Albumin is a protein the liver makes that helps maintain the body’s fluid balance. When the liver is damaged by cirrhosis, it cannot produce enough albumin, leading to a lower blood albumin concentration. This reduces the force that keeps the blood vessels inside, allowing more fluid to seep into the tissues and the peritoneal cavity.
Sodium and water retention. The liver also plays a role in regulating the levels of sodium and water in the body. When the liver is impaired by cirrhosis, it cannot properly signal the kidneys to excrete excess sodium and water. This causes the body to retain more sodium and water, which adds to the fluid accumulation in the abdomen.
What causes alcoholic cirrhosis, and how common is it?
Alcoholic cirrhosis is caused by long-term and heavy drinking of alcohol. Alcohol is a toxin that the liver has to break down and eliminate from the body. When a person drinks more alcohol than the liver can handle, the liver cells become inflamed and injured. Over time, this repeated injury leads to scarring and cirrhosis. The amount and duration of alcohol consumption that can cause alcoholic cirrhosis vary from person to person, depending on factors such as genetics, gender, age, nutrition, and other health conditions. However, according to one 2019 study, about 20% to 25% of people who misuse alcohol by drinking heavily over many years will develop cirrhosis. Alcohol consumption was also estimated to cause a quarter of all cirrhosis-related deaths globally in 2019.
We hope this section has helped you to understand what alcoholic cirrhosis of the liver with ascites is and how it affects your loved one’s health. In the next section, we will discuss the symptoms and complications of this condition and how to recognize them.
What are the Symptoms and Complications of Alcoholic Cirrhosis of the Liver with Ascites?
If your loved one has alcoholic cirrhosis of the liver with ascites, you may notice some changes in their appearance and well-being. These changes are caused by liver damage and the fluid buildup in the abdomen. This section will describe some of this condition’s common symptoms and complications and how to recognize them.
What are the common symptoms of alcoholic cirrhosis and ascites?
The symptoms of alcoholic cirrhosis and ascites may vary from person to person, depending on the severity and stage of the condition. Some of the common symptoms include:
Jaundice: This is a yellowing of the skin and eyes caused by the accumulation of bilirubin, a waste product that the liver normally filters out of the blood. Jaundice can also make the urine dark and the stools pale.
Abdominal swelling: This is caused by fluid accumulation in the abdomen, known as ascites. The abdomen may feel tight, heavy, or bloated. The belly button may stick out or become inverted. The fluid may also cause pressure on the diaphragm, the muscle that helps you breathe, making breathing hard.
Shortness of breath: This is caused by the fluid pressure on the diaphragm and the reduced oxygen-carrying capacity of the blood due to liver damage. Shortness of breath may worsen with exertion or lying down.
Some other symptoms of alcoholic cirrhosis and ascites may include:
Itchy skin or spider-like blood vessels on the skin.
Redness or paleness of the palms of the hands or the fingernails.
For women, irregular or absent periods are not related to menopause.
For men, loss of sex drive, testicular shrinkage, or breast enlargement.
What are the possible complications of alcoholic cirrhosis and ascites?
Alcoholic cirrhosis and ascites can lead to severe and life-threatening complications if left untreated or poorly managed. Some of the possible complications include:
Bleeding: The high pressure in the portal vein, the blood vessel that carries blood from the digestive organs to the liver, can cause the blood to divert to smaller veins that are not equipped to handle the increased volume and pressure. These veins, called varices, can become enlarged and fragile and may rupture and bleed. The most common sites of bleeding are the esophagus and the stomach, but it can also occur in the rectum or the mouth. Bleeding can cause vomiting of blood, black or bloody stools, or shock. The liver damage can also impair the production of clotting factors, making the bleeding harder to stop.
Infection: Bacteria can infect the fluid in the abdomen, causing spontaneous bacterial peritonitis (SBP). This can cause fever, chills, abdominal pain, or confusion. The infection can also spread to the bloodstream, causing sepsis, a life-threatening response to infection. Liver damage can also weaken the immune system, making it harder to fight off infections.
Kidney failure: Fluid retention and reduced blood flow to the kidneys can cause the kidneys to malfunction, leading to a condition called hepatorenal syndrome (HRS). This can cause a decrease in urine output, swelling of the legs and feet, confusion, or coma. Other factors, such as dehydration, infection, or side effects, can cause kidney failure.
Hepatic encephalopathy (HE): Liver damage can cause the buildup of toxins in the blood, such as ammonia, which affects brain function. This can cause confusion, memory loss, personality changes, mood swings, or coma. Other factors, such as bleeding, infection, dehydration, or side effects, can trigger hepatic encephalopathy.
Liver cancer: The chronic inflammation and scarring of the liver can increase the risk of developing liver cancer, also called hepatocellular carcinoma (HCC). Liver cancer can cause symptoms such as abdominal pain, weight loss, jaundice, or ascites. Liver cancer can also spread to other organs, such as the lungs or the bones.
Liver failure: The progressive liver damage can eventually lead to liver failure, also called end-stage liver disease (ESLD). This is when the liver can no longer perform its vital functions, such as filtering toxins, producing bile, or making blood proteins. Liver failure can cause symptoms such as jaundice, ascites, bleeding, infection, kidney failure, hepatic encephalopathy, or liver cancer. Liver failure can also cause multiorgan failure, which is when several organs fail at the same time.
When to seek medical attention for worsening symptoms or complications?
If your loved one has alcoholic cirrhosis and ascites, you should monitor their symptoms and weight regularly and follow the treatment plan prescribed by their healthcare provider. You should also seek medical attention immediately if you notice any of the following signs of worsening symptoms or complications:
Vomiting of blood or black material or passing black or bloody stools.
Fever, chills, abdominal pain, or confusion may indicate an infection.
A decrease in urine output, swelling of the legs and feet, or confusion may indicate kidney failure.
Confusion, memory loss, personality changes, mood swings, or coma may indicate hepatic encephalopathy.
Abdominal pain, weight loss, jaundice, or ascites may indicate liver cancer.
Any other symptoms that cause you or your loved one concern or distress.
We hope this section has helped you to understand the symptoms and complications of alcoholic cirrhosis and ascites and how to recognize them. In the next section, we will discuss the diagnosis and treatment of this condition and how to manage it.
How is Alcoholic Cirrhosis of the Liver with Ascites Diagnosed and Treated?
If your loved one has alcoholic cirrhosis of the liver with ascites, you may want to know how this condition is diagnosed and treated. In this section, we will explain some of the tests and procedures used to confirm the diagnosis and assess the severity of the condition. We will also describe some treatment options and goals to manage the condition and improve your loved one’s quality of life.
What are the diagnostic tests and procedures for alcoholic cirrhosis and ascites?
The diagnosis of alcoholic cirrhosis and ascites is based on a combination of medical history, physical examination, blood tests, and imaging tests. Some of the tests and procedures that are commonly used include:
Medical history and physical examination. Your healthcare provider will ask you and your loved one about the history of alcohol use, symptoms, medications, and other health conditions. Your provider will also examine your loved one’s abdomen, skin, eyes, and legs for signs of fluid buildup, jaundice, bleeding, or infection. Your provider may also measure the size and shape of the liver and spleen by feeling them through the abdominal wall.
Blood tests. Your provider will order blood tests to check the liver function, kidney function, blood count, clotting ability, and infection status of your loved one. Some of the blood tests that are used include:
Liver function tests measure the levels of certain enzymes and substances that reflect the liver’s ability to filter toxins, produce bile and blood proteins, and regulate blood sugar. Some of the liver function tests are alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), bilirubin, albumin, and glucose.
Kidney function tests measure the creatinine level, a waste product the kidneys typically remove from the blood. An elevated level of creatinine may indicate kidney failure, which can be a complication of cirrhosis and ascites.
Blood count: This test measures the number and type of blood cells, such as red blood cells, white blood cells, and platelets. A small number of blood cells may indicate bleeding, infection, or bone marrow suppression, which can be caused by cirrhosis or alcohol use.
The clotting test measures the prothrombin time (PT) or the international normalized ratio (INR), reflecting the blood’s clot ability. A prolonged PT or INR may indicate a deficiency of clotting factors produced by the liver. A low level of clotting factors may increase the risk of bleeding, especially from the varices (enlarged veins) in the esophagus or stomach.
The infection test measures the C-reactive protein (CRP) level, a marker of inflammation and infection. An elevated level of CRP may indicate an infection, such as spontaneous bacterial peritonitis (SBP),a severe complication of ascites. Your provider may also order blood cultures to identify the type of bacteria causing the infection.
Imaging tests. Your provider may order imaging tests to examine the structure and function of the liver and other organs in the abdomen. Some of the imaging tests that are used include:
Ultrasound: This test uses sound waves to create images of the liver and other organs. It can show the liver’s size, shape, texture, and presence of fluid, tumors, or blood clots. It can also measure the blood flow and pressure in the portal vein, which carries blood from the digestive organs to the liver. A high pressure in the portal vein, called portal hypertension, can cause ascites and varices.
Computed tomography (CT) scan: This test uses X-rays to create detailed images of the liver and other organs. It can show the extent of liver damage and the presence of fluid, tumors, or blood clots. It can also measure the blood flow and pressure in the portal vein.
Magnetic resonance imaging (MRI) scan: This test uses a magnetic field and radio waves to create detailed images of the liver and other organs. It can show the extent of liver damage and the presence of fluid, tumors, or blood clots. It can also measure the blood flow and pressure in the portal vein.
Elastography: This test uses ultrasound or MRI to measure the stiffness of the liver tissue, which reflects the degree of scarring or fibrosis. A stiffer liver indicates more advanced cirrhosis. There are two types of elastography: transient elastography and magnetic resonance elastography (MRE). Transient elastography uses a device that sends vibrations to the liver and measures the speed of the sound waves. MRE uses a device that creates waves in the liver and measures the displacement of the liver tissue.
Liver biopsy. This procedure involves taking a small sample of liver tissue and examining it under a microscope. It can show the extent and cause of liver damage, as well as the presence of cancer cells. A liver biopsy is not always necessary for the diagnosis of alcoholic cirrhosis and ascites. Still, it may be done if other tests are inconclusive or if there is a suspicion of another cause of liver disease. A liver biopsy can be done by inserting a thin needle through the skin into the liver (percutaneous biopsy), by inserting a thin tube through a vein in the neck into the liver (trans jugular biopsy), or by making a small incision in the abdomen and using a special instrument to obtain the tissue (laparoscopic biopsy).
What are the treatment options and goals for alcoholic cirrhosis and ascites?
The treatment of alcoholic cirrhosis and ascites depends on the cause and severity of the condition, as well as the symptoms and complications that your loved one may have. The main goals of treatment are to prevent further liver damage, to reduce the fluid buildup in the abdomen, and to prevent or treat the symptoms and complications of the condition. Some of the treatment options and goals that are available include:
Alcohol abstinence. The most important and effective treatment for alcoholic cirrhosis and ascites is to stop drinking alcohol completely. Alcohol is a toxin that damages the liver and worsens the condition. Stopping alcohol use can improve liver function, reduce inflammation, and slow down the progression of cirrhosis. It can also improve the symptoms and complications of the condition, such as ascites, bleeding, infection, kidney failure, and hepatic encephalopathy. Alcohol abstinence can also increase the chances of survival and the eligibility for liver transplantation, which is the only definitive treatment for end-stage liver disease. However, stopping alcohol use can be exceedingly difficult, especially for people who have alcohol use disorder (AUD). This chronic and relapsing condition affects the brain and causes a strong urge to drink. If your loved one has AUD, they may need professional help and support to quit drinking. There are several types of treatments for AUD, such as counseling, behavioral therapy, medication, and mutual support groups. Your healthcare provider can help you and your loved one find the best treatment option for AUD.
Medication. Your healthcare provider may prescribe medication to treat the symptoms and complications of alcoholic cirrhosis and ascites. Some of the medicines that are used include:
Diuretics: These drugs help the body eliminate excess fluid and salt through the urine. They can reduce the fluid buildup in the abdomen and the legs and improve the breathing and the comfort of your loved one. The most common diuretics that are used for ascites are spironolactone and furosemide. Your healthcare provider will adjust the dose of the diuretics according to your loved one’s weight, blood pressure, and blood tests. Diuretics can have side effects, such as dehydration, low blood pressure, low sodium, high potassium, kidney failure, and hepatic encephalopathy. Therefore, your loved one will need regular blood tests and follow-up visits to monitor the effects of the diuretics. Your loved one must also limit salt and fluid intake, as your healthcare provider has advised.
Antibiotics are drugs that kill or stop the growth of bacteria that cause infection. They can prevent or treat fluid infection in the abdomen, called spontaneous bacterial peritonitis (SBP), a serious complication of ascites. The most common antibiotics used for SBP are cefotaxime, ciprofloxacin, and norfloxacin. Your healthcare provider will decide which antibiotic to use and for how long based on the symptoms, blood tests, and fluid tests of your loved one. Antibiotics can have side effects, such as allergic reactions, diarrhea, nausea, and rash. Therefore, your loved one must report any side effects to your healthcare provider. Your loved one may also need to take antibiotics regularly to prevent SBP from happening again, especially if they have an elevated risk of recurrence.
Lactulose: This type of sugar helps lower the ammonia level in the blood. This toxin can cause hepatic encephalopathy (HE), a complication of cirrhosis that affects brain function. Lactulose draws water into the bowel, making the stool softer and more frequent. This helps to flush out the ammonia from the colon, where the bacteria produce it. Lactulose also changes the colon’s acidity, inhibiting the growth of ammonia-producing bacteria. Lactulose can prevent or treat the symptoms of HE, such as confusion, memory loss, personality changes, mood swings, or coma. Lactulose is taken by mouth, usually two to four times a day. The dose of lactulose is adjusted according to the number and consistency of the stools and the level of consciousness of your loved one. Lactulose can have side effects, such as bloating, gas, cramps, diarrhea, or dehydration. Therefore, your loved one will need regular blood tests and follow-up visits to monitor the effects of lactulose. Your loved one may also need to take lactulose regularly to prevent HE from happening again, especially if they have a history of recurrent episodes.
Beta-blockers: These are drugs that lower blood pressure and heart rate. They can reduce the pressure in the portal vein, the blood vessel that carries blood from the digestive organs to the liver, and prevent or reduce the bleeding from the varices (enlarged veins) in the esophagus or stomach, a severe complication of cirrhosis and ascites. The most common beta blockers used for variceal bleeding are propranolol and nadolol. Your healthcare provider will prescribe the dose of the beta blockers according to the blood pressure and heart rate of your loved one. Beta-blockers can have side effects, such as fatigue, dizziness, shortness of breath, or depression. Therefore, your loved one will need regular blood tests and follow-up visits to monitor the effects of the beta blockers. Your loved one may also need to take beta blockers regularly to prevent variceal bleeding from happening again, especially if they have a history of previous episodes.
Other medication: Your healthcare provider may prescribe other medicines to treat the symptoms and complications of alcoholic cirrhosis and ascites, depending on the specific needs and conditions of your loved one. Some of the different medications that may be used include:
Pain relievers: These are drugs that help to relieve pain and discomfort. Your healthcare provider will recommend the type and dose of pain relievers that are safe and effective for your loved one. Some of the pain relievers that may be used are acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or opioids. However, some pain relievers can have side effects or interactions with other medications, such as liver toxicity, bleeding, kidney failure, or hepatic encephalopathy. Therefore, your loved one should not take any pain relievers without consulting your healthcare provider. Your loved one should also avoid alcohol, which can worsen liver damage and pain.
Antipruritics: These drugs help relieve itching, which can be a symptom of cirrhosis and jaundice. Your healthcare provider will prescribe the type and dose of antipruritics that are safe and effective for your loved one. Some antipruritics that may be used are cholestyramine, rifampin, or naltrexone. However, some antipruritics can have side effects or interactions with other drugs, such as constipation, nausea, rash, or liver toxicity. Therefore, your loved one should not take any antipruritics without consulting your healthcare provider. Your loved one should also avoid alcohol, which can worsen liver damage and itching.
Antacids: These drugs help neutralize the acid in the stomach and prevent or treat ulcers, which can be a complication of cirrhosis and variceal bleeding. Your healthcare provider will prescribe the type and dose of antacids that are safe and effective for your loved one. Some antacids that may be used are proton pump inhibitors (PPIs), histamine-2 receptor blockers (H2 blockers), or sucralfate. However, some antacids can have side effects or interactions with other drugs, such as diarrhea, headache, infection, or bleeding. Therefore, your loved one should not take antacids without consulting your healthcare provider. Your loved one should also avoid alcohol, which can worsen liver damage and ulcers.
Paracentesis: This procedure involves draining the fluid from the abdomen using a needle or a catheter. It can relieve the pressure and discomfort caused by the fluid buildup and improve the breathing and kidney function of your loved one. Paracentesis can be done as a one-time or a repeated procedure, depending on the amount and recurrence of the fluid. Paracentesis can also obtain a fluid sample for testing to diagnose or treat an infection or cancer. Paracentesis is usually done under local anesthesia, with or without sedation, in a hospital or an outpatient clinic. Paracentesis can have complications, such as bleeding, infection, or injury to the organs. Therefore, your loved one will need regular blood tests and follow-up visits to monitor the effects of paracentesis. Your loved one may also need to take medication, such as albumin, to prevent a drop in blood pressure or a worsening of kidney function after paracentesis.
Trans jugular intrahepatic portosystemic shunt (TIPS): This procedure involves creating a new pathway for the blood to flow from the portal to the hepatic vein, bypassing the liver. This can lower the pressure in the portal vein and reduce the fluid buildup in the abdomen and the bleeding from the varices. TIPS can improve the symptoms and complications of cirrhosis and ascites and increase the survival of your loved one. TIPS is done by inserting a thin tube through a vein in the neck into the liver and placing a metal stent to keep the new pathway open. TIPS is usually done under general anesthesia in a hospital. TIPS can have complications, such as bleeding, infection, or hepatic encephalopathy. Therefore, your loved one will need regular blood and imaging tests to monitor the effects of TIPS. Your loved one may also need to take medication, such as beta-blockers or anticoagulants, to prevent the blockage or clotting of the stent.
Liver transplantation: This surgery involves replacing the damaged liver with a healthy liver from a deceased or a living donor. This can cure cirrhosis and ascites and restore the normal liver function and quality of life of your loved one. Liver transplantation is the only definitive treatment for end-stage liver disease when the liver can no longer perform its vital functions. Liver transplantation is done under general anesthesia in a hospital. Liver transplantation can have complications, such as bleeding, infection, or rejection of the new liver. Therefore, your loved one will need to have regular blood tests and follow-up visits to monitor the effects of liver transplantation. Your loved one will also need to take medication, such as immunosuppressants, to prevent the rejection of the new liver.
What is the role of alcohol abstinence and liver transplantation in managing alcoholic cirrhosis and ascites?
As mentioned earlier, alcohol abstinence is the most important and effective treatment for alcoholic cirrhosis and ascites. Alcohol abstinence can improve the liver function, reduce the inflammation, and slow down the progression of cirrhosis. It can also improve the symptoms and complications of the condition, such as ascites, bleeding, infection, kidney failure, and hepatic encephalopathy. Alcohol abstinence can also increase the chances of survival and the eligibility for liver transplantation, which is the only definitive treatment for end-stage liver disease.
However, alcohol abstinence can be exceedingly challenging, especially for people who have alcohol use disorder (AUD). This chronic and relapsing condition affects the brain and causes a strong urge to drink. If your loved one has AUD, they may need professional help and support to quit drinking. There are several types of treatments for AUD, such as counseling, behavioral therapy, medication, and mutual support groups. Your healthcare provider can help you and your loved one find the best treatment option for AUD.
Liver transplantation is a surgery that involves replacing the damaged liver with a healthy liver from a deceased or a living donor. Liver transplantation can cure cirrhosis and ascites and restore the normal liver function and quality of life of your loved one. However, liver transplantation is not a simple or easy procedure. It has many risks and challenges, such as the shortage of donor organs, the long waiting list, the strict selection criteria, the complex surgery, the possible complications, and the lifelong medication and follow-up. Therefore, liver transplantation is reserved for patients who have end-stage liver disease, when the liver can no longer perform its vital functions, and who have no other treatment options.
One of the main selection criteria for liver transplantation is alcohol abstinence. Patients who have alcoholic cirrhosis and ascites must demonstrate a period of alcohol abstinence before they can be considered for liver transplantation. The duration of alcohol abstinence may vary from center to center, but it is usually at least six months. This is to ensure that the patients are committed to quitting alcohol and that they have an insignificant risk of relapse and graft failure after the transplantation. However, some patients may not be able to achieve or maintain alcohol abstinence, or they may have a rapid deterioration of liver function that does not allow them to wait for six months. In these cases, some centers may consider liver transplantation for patients who have shorter periods of alcohol abstinence or who have not abstained at all if they meet certain criteria, such as having strong social support, undergoing an addiction assessment and treatment, and signing a contract to abstain from alcohol after the transplantation.
We hope this section has helped you to understand the diagnosis and treatment of alcoholic cirrhosis and ascites and how to manage it. In the next section, we will discuss how to care for someone with alcoholic cirrhosis and ascites.
How to Care for Someone with Alcoholic Cirrhosis of the Liver with Ascites?
If you are caring for someone who has alcoholic cirrhosis of the liver with ascites, you may face many challenges and responsibilities. You may have to help your loved one with their daily activities, such as bathing, dressing, eating, and taking medication. You may also have to monitor their symptoms and weight and report any changes or problems to their healthcare provider. You may also have to deal with the emotional and social impact of the condition, such as stress, anxiety, depression, isolation, or stigma. In this section, we will provide some practical tips and advice for caregivers and family members, as well as some emotional support and resources.
Practical tips and advice for caregivers and family members
As a caregiver or a family member, you can play a significant role in helping your loved one manage their condition and improve their quality of life. Here are some practical tips and advice that you can follow:
Monitor weight and fluid intake. One of the main goals of treatment for alcoholic cirrhosis and ascites is to reduce the fluid buildup in the abdomen and the legs. You can help your loved one achieve this goal by regularly monitoring their weight and fluid intake. You should weigh your loved one every morning before breakfast and record their weight in a diary or a chart. You should also measure and record their fluid intake, including water, juice, milk, soup, and other beverages. You should report any sudden or significant changes in weight or fluid intake to their healthcare provider, as they may indicate a worsening condition or need to adjust the medication or the treatment plan. You should also follow the advice of their healthcare provider regarding the limit of salt and fluid intake, as too much salt and fluid can worsen fluid retention and the symptoms of the condition.
Prevent infection and skin breakdown. Another goal of treatment for alcoholic cirrhosis and ascites is to prevent or treat the infection of the fluid in the abdomen, called spontaneous bacterial peritonitis (SBP), which is a severe complication of the condition. You can help your loved one prevent SBP by ensuring they take their prescribed antibiotics regularly and as directed by their healthcare provider. You should also watch for signs of infection, such as fever, chills, abdominal pain, or confusion, and seek medical attention immediately if you notice any of them. You can also help your loved one prevent skin breakdown, which can be caused by the pressure and friction of the fluid on the skin, especially in the lower abdomen, the groin, and the buttocks. You can do this by keeping the skin clean and dry, applying moisturizer and barrier cream, changing the position of your loved one frequently, and using pillows or cushions to reduce the pressure on the skin. You should also check the skin regularly for signs of breakdown, such as redness, swelling, blisters, or sores, and report them to their healthcare provider.
Manage pain and discomfort. Another goal of treatment for alcoholic cirrhosis and ascites is to relieve the pain and discomfort that your loved one may experience due to the fluid buildup, liver damage, or the complications of the condition. You can help your loved one manage their pain and discomfort by giving them their prescribed pain relievers regularly and as directed by their healthcare provider. You should also avoid giving them any over-the-counter pain relievers, such as aspirin, ibuprofen, or naproxen, without consulting their healthcare provider, as they may have side effects or interactions with other drugs, such as liver toxicity, bleeding, kidney failure, or hepatic encephalopathy. You should also avoid giving them alcohol, which can worsen liver damage and pain. You can also help your loved one manage their pain and discomfort using non-drug methods, such as massage, heat, cold, relaxation, distraction, or music. You should also encourage your loved one to express their feelings and concerns about their pain and discomfort and listen to them with empathy and respect.
Emotional support and resources for caregivers and family members
Caring for someone who has alcoholic cirrhosis and ascites can be incredibly stressful and demanding. You may feel overwhelmed, frustrated, angry, guilty, or depressed. You may also feel isolated, lonely, or stigmatized. You may have to deal with financial, legal, or social issues. You may have to balance your caregiving role with other roles and responsibilities, such as work, family, or personal life. You may also have to cope with the uncertainty and the grief of losing your loved one. These challenges can affect your physical, mental, and emotional health and quality of life. Therefore, you must take care of yourself and your loved ones. Here are some tips and resources that can help you provide emotional support and care for yourself and your loved one:
Seek professional help. If you or your loved one are struggling with alcohol use disorder (AUD), depression, anxiety, or any other mental health condition, you should seek professional help and treatment. Several types of treatments are available, such as counseling, therapy, medication, and support groups. Your healthcare provider can help you and your loved one find the best treatment option for your condition. You should also follow the treatment plan and the advice of your healthcare provider and report any side effects or problems to them. (See “Risky drinking and alcohol use disorder: Epidemiology, clinical features, adverse consequences, screening, and assessment,” “Pharmacotherapy for alcohol use disorder,” “Psychosocial treatment of alcohol use disorder,” and “Brief interventions for unhealthy alcohol and other drug use” and “Unipolar depression in adults: Assessment and diagnosis” and “Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis.”)
Communicate with the patient and the healthcare team. Communication is key to providing your loved one the best care and support. You should communicate with your loved one regularly and openly and listen to their needs, preferences, and concerns. You should also communicate with their healthcare team frequently and effectively and share any information, questions, or feedback you have. You should also participate in decision-making and care planning for your loved one and respect their wishes and goals. You should also ask for help or clarification and advocate for your loved one’s rights and interests. (See “Communication skills for patient-centered care: Communication during specific situations.”)
Access support groups and counseling. Support groups and counseling can provide you and your loved one emotional support, information, education, and guidance. They can also help you and your loved one connect with others going through similar experiences and challenges and share your stories, feelings, and coping strategies. Depending on your preference and availability, you can find support groups and counseling services online, by phone, or in person. You can also ask your healthcare provider or local community for recommendations or referrals.
Some of the support groups and counseling services that are available for people with alcoholic cirrhosis and ascites and their caregivers and family members are:
American Liver Foundation: This is a national nonprofit organization that provides information, education, advocacy, and support for people with liver disease and their families. It offers online resources, webinars, newsletters, publications, and a helpline. It also has local chapters and divisions that organize support groups, events, and programs.
Alcoholics Anonymous: This is a worldwide fellowship of people who have a problem with alcohol and want to stop drinking. They offer a 12-step recovery program, meetings, literature, and online resources. They also have a special group for people who have liver disease and want to quit drinking, called the Liver Transplant Group.
Family Caregiver Alliance: This is a national nonprofit organization that provides information, education, advocacy, and support for family caregivers of people with chronic, disabling, or life-limiting conditions. It offers online resources, webinars, newsletters, publications, and a caregiver connect service. The Alliance also has a network of state and local agencies that provide direct services, such as counseling, respite care, legal assistance, and support groups.
Caregiver Action Network: This is a national nonprofit organization that provides information, education, advocacy, and support for family caregivers of people with any condition. It offers online resources, webinars, newsletters, publications, and a caregiver help desk. It also has a partner organization network that provides direct services, such as counseling, respite care, legal assistance, and support groups.
What to Expect and How to Care for Someone in the Terminal Stage of Alcoholic Cirrhosis of the Liver?
What is the terminal stage of alcoholic cirrhosis of the liver, and how does it differ from the earlier stages?
Alcoholic cirrhosis of the liver is a condition where the liver is severely damaged by long-term alcohol abuse, leading to scarring and loss of function. The terminal stage of alcoholic cirrhosis of the liver is also known as decompensated cirrhosis, which means that the liver can no longer perform its vital roles, such as filtering toxins, producing bile, and regulating blood clotting.
In the earlier stages of alcoholic cirrhosis of the liver, also known as compensated cirrhosis, the liver may still be able to function despite the damage, and the patient may not have any symptoms or only mild ones. In the terminal stage, the patient may experience severe and life-threatening complications, such as bleeding from enlarged veins in the esophagus or stomach, fluid accumulation in the abdomen or legs, infection, kidney failure, brain damage, or liver cancer.
What are the common signs and symptoms of the terminal stage of alcoholic cirrhosis of the liver?
The signs and symptoms of the terminal stage of alcoholic cirrhosis of the liver may vary depending on the type and severity of the complications, but some of the common ones include:
Jaundice is a yellowing of the skin and eyes due to elevated bilirubin levels, a waste product that the liver typically removes from the blood.
Ascites, an abdomen swelling due to fluid buildup, are caused by portal hypertension, a high blood pressure in the veins that carry blood to the liver from the intestines and spleen.
Edema, which is a swelling of the legs or feet due to fluid retention, is also caused by portal hypertension.
Variceal bleeding, which is bleeding from enlarged and fragile veins in the esophagus or stomach, is also caused by portal hypertension. This can lead to vomiting blood, black or tarry stools, or shock.
Hepatic encephalopathy is a brain disorder due to the accumulation of toxins in the blood that the liver cannot filter. This can cause confusion, mood changes, memory loss, slurred speech, tremors, or coma.
Hepatorenal syndrome is kidney failure caused by reduced blood flow to the kidneys, caused by low blood pressure, and liver dysfunction. This can lead to decreased urine output, dark urine, or swelling.
Spontaneous bacterial peritonitis is an infection of the fluid in the abdomen caused by bacteria that enter the bloodstream from the intestines or other sources. It can cause fever, abdominal pain, or tenderness.
Hepatocellular carcinoma is a liver cancer that can develop in people with cirrhosis. This can cause weight loss, loss of appetite, abdominal pain, or jaundice.
What is the prognosis and life expectancy of the terminal stage of alcoholic cirrhosis of the liver?
The prognosis and life expectancy of the terminal stage of alcoholic cirrhosis of the liver are poor, as there is no cure for the condition, and the complications are often fatal. Life expectancy depends on several factors, such as the cause and extent of liver damage, the type and number of complications, the response to treatment, and the patient’s general health. According to some studies, the average life expectancy of people with decompensated cirrhosis is about two years, but it can vary from a few months to several years. Please seek hospice services for any prognosis of six months or less.
Conclusion
In this article, we have discussed the diagnosis and treatment of alcoholic cirrhosis of the liver with ascites. This severe and challenging condition affects both the patient and their loved ones. We have also discussed how to care for someone in this condition, what to expect, and how to prepare for the end of life.
