Complications of liver cirrhosis? Don’t be afraid! There are ways to deal with it!

Author: Wang Xiangxiang, The Fifth Medical Center, PLA General Hospital

Reviewer: Jin Bo, Chief Physician, Fifth Medical Center, PLA General Hospital

Cirrhosis, a word that sounds scary, is actually the helpless sigh of the liver after silently enduring the vicissitudes of life. It is like an old machine, with internal parts gradually wearing out and its functions declining. The accumulation of ascites, swelling of the scrotum, and protrusion of the navel... These complications are like alarm lights on the machine, flashing continuously, reminding us of the seriousness of the problem. Understanding the root causes of cirrhosis and its complications is like finding the key to solving a difficult problem, allowing us to formulate more accurate response strategies. From adjusting lifestyle habits to scientific treatment, every step is full of hope and possibility.

1. Why do patients with decompensated cirrhosis develop ascites?

Under normal conditions, there is about 50 ml of fluid in the human abdominal cavity, which acts as a lubricant for the intestines. Under any pathological conditions, the increase in the amount of fluid in the abdominal cavity exceeding 200 ml is called ascites. The appearance of ascites is one of the main signs that cirrhosis has entered the decompensated stage. More serious patients often have symptoms such as abdominal distension, loss of appetite, and edema of both lower limbs. In severe cases, umbilical hernia, scrotal edema, and pleural effusion may even occur. In most patients, ascites can gradually subside after systemic treatment.

Ascites in cirrhosis is often the result of the combined action of several factors.

1. Portal hypertension: It is the main cause and initiating factor of ascites in cirrhosis. Cirrhosis causes deformation and blockage of intrahepatic blood vessels, obstruction of portal vein blood return, increased intravascular pressure of portal vein system, increased water pressure at the venous end of capillaries, and water leakage into the abdominal cavity.

2. Increased activity of the renin-angiotensin-aldosterone system: This is the main reason for the formation of ascites and its difficulty in disappearing. When portal hypertension occurs, the blood flow in the veins increases and the central blood flow decreases, thus stimulating the kidneys to secrete excessive aldosterone, leading to water and sodium retention and exacerbating the formation of ascites.

3. The secretion or activity of vasoactive substances such as atrial natriuretic peptide and prostaglandins increases.

4. Hypoalbuminemia: After cirrhosis, the liver's ability to synthesize albumin decreases, resulting in a decrease in the albumin content in the blood and a decrease in plasma colloidal osmotic pressure. Water will leak from the plasma into the tissues, causing ascites and edema.

5. Obstruction of lymphatic return: In cirrhosis, the intrahepatic blood vessels are blocked and the production of hepatic lymph increases. When the returning lymph exceeds the collection capacity of the thoracic duct, ascites may occur.

2. How to determine the amount of ascites?

In clinical practice, the amount of ascites is often graded (called grades in my country) based on symptoms, signs, and ultrasound examination results. Grade 1 (mild) is a small amount of ascites, grade 2 (moderate) is moderate to severe ascites, and grade 3 (severe) is a large amount of ascites.

Grade 1.1: Ascites that can only be detected by ultrasound. The patient generally has no abdominal distension and negative shifting dullness on physical examination; ultrasound shows ascites in various intestinal spaces with a depth of less than 3 cm.

Grade 2.2: Patients often have mild to moderate abdominal distension and symmetrical abdominal bulge. Physical examination shows negative/positive shifting dullness; ultrasound shows ascites submerging the intestines but not crossing the mid-abdomen, with a depth of 3 to 10 cm.

Grade 3.3: The patient has obvious abdominal distension, and physical examination shows positive shifting dullness. There may be abdominal distension and even umbilical hernia formation. Ultrasound shows that ascites occupies the entire abdominal cavity, and the mid-abdomen is filled with ascites with a depth of >10 cm.

3. What should patients with cirrhosis do if they experience scrotal edema?

1. Keep the scrotum clean to reduce urine irritation; clean the perineum every night.

2. Move slowly when turning over, and avoid dragging, pulling, or tugging; the skin of the edematous scrotum is very thin, so friction of the edematous skin should be avoided to prevent ulceration and infection, which will aggravate the condition.

3. Raise the scrotum: Patients with mild scrotal edema should limit their activities, while patients with excessive scrotal edema should absolutely stay in bed and rest.

To alleviate the discomfort of scrotal prolapse, the following measures can be taken: ① Pad support method: fold a cotton pad or cotton towel and place it under the scrotum to raise the scrotum. The size should be based on the size of the scrotum, and the height should be comfortable without a sense of prolapse. ② Homemade water bag method with latex gloves: latex gloves are soft and less irritating, making the patient feel comfortable. Fill the latex gloves with 2/3 of water and tie them tightly, then place a cotton pad on top to lift the scrotum.

4. Wrap the scrotum with a T-belt or a triangle belt to prevent it from falling and aggravating edema, and also help the edema to subside.

5.50% magnesium sulfate wet compress: Soak gauze in magnesium sulfate and apply it to the scrotum. It has anti-inflammatory and detumescent effects. Apply it once in the morning and evening for 30 minutes each time.

6. If the scrotal edema is too large, you can use liquid dressings to apply to the intact skin of the scrotum to increase the moisture of the skin. You can also combine alginate and apply it to the bilateral groin to protect the skin and avoid groin skin ulceration. Wear soft, sweat-absorbent, loose cotton clothes and trousers. Tight underwear is not recommended.

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4. What is the cause of umbilical hernia in patients with liver cirrhosis? What should be done if umbilical hernia occurs?

1. Cause: Patients with cirrhosis, portal hypertension and a large amount of ascites have increased intra-abdominal pressure and increased abdominal wall tension, which causes the intestinal contents to bulge out of the weak areas of the navel or groin, forming umbilical hernia and femoral hernia, among which umbilical hernia is more common.

2. Treatment of umbilical hernia

(1) Avoid actions that may suddenly increase the intra-abdominal pressure, such as severe coughing, straining during bowel movements, nausea, vomiting, and weight bearing.

(2) Pay attention to protecting the local skin. First clean the umbilical hernia with 0.9% sodium chloride solution or warm water, and apply "liquid dressing" after it dries. After 1 to 2 hours, gently rub the umbilical hernia with your palm to make it return to the abdominal cavity, and then stick a hydrocolloid dressing with the navel as the center for protection. This can not only prevent the skin at the umbilical hernia from rupturing and reduce the chance of infection, but also increase the patient's comfort when changing body position.

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(3) You can use a belly band to wrap around the abdomen to protect the umbilicus or use a homemade "gauze roll" + adhesive tape cross-shaped for external fixation.

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