Uncover the truth behind abdominal bloating and edema, and unlock tips for coping with it!

Author: Yu Xiaoli, The Fifth Medical Center, PLA General Hospital

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

Cirrhosis is not only the result of fibrous tissue proliferation after liver cell damage, but also a long-lasting health alarm. As cirrhosis progresses, its harm gradually becomes apparent, like a silent storm, attacking the patient's body and life. Among them, abdominal distension and edema, as common complications of cirrhosis, make patients miserable. Understanding the root causes of these complications and mastering effective coping measures are undoubtedly a key step for patients with cirrhosis to regain a healthy life. Today we will delve into the deep causes of abdominal distension and edema in patients with cirrhosis, and present a series of scientific and practical coping strategies to help patients with cirrhosis better manage the disease and regain the beauty and hope of life.

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1. What is the cause of abdominal distension in patients with liver cirrhosis? What should be done if abdominal distension occurs?

1. Causes of abdominal distension: Ascites, intra-abdominal tumors, gastrointestinal dysfunction, hypokalemia, gas accumulation, food accumulation or feces accumulation caused by various reasons are the main causes of abdominal distension in patients with cirrhosis. Patients experience obvious abdominal distension after eating, especially in the afternoon and after dinner.

2. Treatment and care of abdominal distension

(1) Diet: Develop good eating habits, avoid overeating, eat small meals frequently, chew slowly when eating, and avoid eating too fast, talking while eating, etc. Bad habits will cause patients to swallow a lot of gas and cause bloating. Patients should avoid eating foods that produce a lot of gas, such as milk, soy milk, soda, bread, cereals, beans, etc.; avoid consuming foods that are difficult to digest or too sweet or sour, as well as coffee, strong tea, etc.; eat fiber-containing foods in moderation, and drink yogurt in moderation if the condition permits, to regulate the intestinal flora.

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(2) Appropriate activities: Patients whose condition permits can get out of bed, take a walk, or do some housework to promote intestinal peristalsis, maintain smooth bowel movements, and eliminate abdominal bloating.

(3) Symptomatic treatment:

① Abdominal massage. When the patient's condition allows, he or she can lie flat and bend the lower limbs to relax the abdominal muscles. First, rub the hands together, press the warm palm of the right hand flat on the abdominal wall, and put the left hand on the right hand. First, rub the palm in a clockwise direction around the navel for 2 to 3 minutes, and then start massaging from the right lower abdomen in a clockwise direction, that is, right lower abdomen → right upper abdomen → left upper abdomen → left lower abdomen, massage 10 to 20 circles, 5 to 10 minutes, once in the morning and evening. The massage should be done 1 hour after a meal, with moderate strength, without fatigue or discomfort.

②Wrap a hot water bottle with a towel and apply heat to the abdomen. Be careful not to get burned (this method is not recommended for patients with esophageal and gastric varices).

③ Apply hot compress to the navel with fennel salt pack. Fennel is warm in nature, spicy in taste, has no adverse reactions, and can warm the liver and kidneys, regulate qi and stomach, aid digestion, and regulate the gastrointestinal tract. It can remove gas, disperse fragrance and relieve pain when the abdomen is bloated. Large-grain sea salt can treat food retention, abdominal distension and pain, and constipation; the combination of fennel and large-grain sea salt is very effective in treating abdominal distension.

④ Apply 1g of musk + Ampo patch to the navel. In the late stage of liver cirrhosis, gas accumulation in the intestines can cause abdominal distension. Musk can invigorate blood circulation and disperse knots. It has good volatility and can quickly enter the muscles, stimulate the gastrointestinal tract, promote gastrointestinal motility, and promote gastrointestinal exhaust. Pregnant women should avoid contact when using musk.

(4) Take medication as directed by your doctor: such as lactulose, enema, dimethicone powder, simethicone emulsion, Ma Ren Run Chang pills, etc.

2. What are the causes of edema in patients with liver cirrhosis? How is edema graded? What should be done if edema of both lower limbs occurs?

1. Causes of edema: Liver damage will affect the synthesis of albumin, leading to hypoproteinemia in the body. Edema will first appear in the lower parts of the body, and edema of the lower limbs is more typical.

2. Grading of edema: Clinically, edema can be divided into three degrees: mild, moderate and severe.

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3. Countermeasures for lower limb edema

(1) Rest and activity: Patients with mild edema should limit their activities appropriately, and patients with severe edema should rest in bed in an appropriate position. They should reduce the time spent standing or sitting, and lie flat as much as possible. When lying flat, they should place cotton pillows on both lower limbs or raise both lower limbs 15° to 30° at the same time to increase venous return and reduce edema. However, it should be noted that this method is not suitable for patients with cardiogenic edema. They can usually wear cotton, wide, comfortable cloth shoes or cotton slippers. Patients with severe edema should be careful to prevent falls.

(2) Diet: Reasonably limit sodium salt intake, appropriately control water intake, and eat a moderate amount of high-quality protein. In principle, the sodium salt intake should be 4 to 6 g per day. A low-salt diet can easily lead to a decrease in appetite, so the diet can be diversified, and appropriate foods, cooking methods and ingredients can be selected to improve the patient's appetite.

(3) Monitor body weight, accurately record urine volume, and, if necessary, record 24-hour intake and output. Quantify food intake as much as possible (i.e., how much water it contains) in order to objectively record the disappearance of edema.

(4) Take medication as directed by the doctor: Use diuretics such as spironolactone, furosemide, torsemide, etc. Those with significantly reduced albumin need to supplement human serum albumin. Avoid stopping medication or changing the dosage without permission, and observe any adverse reactions during medication.

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