Your Ascites Management Plan

Nurse Led Ascites Management Team Patient Information Leaflet

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Ascites is the medical term given to the build up of fluid in the tummy between the organs and the wall of the tummy. The fluid can build up steadily over a few weeks or develop quite quickly over a few days. What causes this? Most commonly this is caused by cirrhosis of the liver. Cirrhosis is a long term condition that is caused by scarring of the liver. What are the symptoms • Fluid in the tummy can cause a swollen tummy that can become painful. • Weight gain. • Breathlessness. • Unable to eat full meals. Sometimes the fluid in the tummy can become infected which can cause worsening tummy pain and high temperature. You can become a little confused. If you experienced these symptoms you would need to visit your doctor right away. Tests You May Have Had Ultrasound scan – this looks at your liver and can look for fluid in the tummy. Diagnostic Tap – This is where a sample of the tummy fluid is taken (after the skin is numbed using a needle and syringe). This fluid will be sent to the laboratory to be tested for any infection. If the test comes back positive you will need antibiotics. Paracentesis – or ascitic drain – This is where the skin is numbed on the left side of the stomach. A tube is then inserted to drain the fluid that has collected inside the tummy in order to ease the symptoms. Drainage can be anything from 2 litres to 15 litres! Page 2

What Treatment/Monitoring is there for the Fluid Build Up? Diuretics – (water tablets) – You may be prescribed these to help prevent / control the fluid build up. This tablet can make you pass more urine than normal. You will need your bloods checking regularly whilst on this medication (see page 9). Paracentesis – where the fluid is drained from the abdomen over a period of 6 – 8 hours. (see above) What can I do to help? Follow low sodium diet to help prevent future build up. (see Low sodium diet section) Follow fluid restriction as instructed. (see My fluid restriction section) Daily weights and abdominal girth measurements. How can I monitor my ascites? We would like you to help monitor your condition so we can give you the best care. There are several things we want you to do. Daily Weight (Complete chart on page 4 & 5 ) • Weigh at the same time daily • Use the same set of scales • If you put on 4kg (approximately 9 pounds) you should contact us. Your weight should remain steady. If you start to put on weight it may indicate you are building up fluid again.

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Low Sodium Diet (low salt diet) Sodium, or salt, is the main ingredient in table salt. It is also found in lots of food. Although the body does need a certain amount of sodium to work normally, most people eat more salt than they need. Checking the label is the best way to see the amount of sodium in the food you are eating. What foods contain the most sodium? Processed foods contain high amounts of sodium. These usually come in cans, packets, jars. Examples of high sodium foods:- crisps, pot noodles, ready meals, salted peanuts. Dietitian • Whilst you were in you did / did not see the dietitian. • You have / have not been given an information sheet from the dietitian to use. My fluid restriction (complete as required) Restricting the fluid intake can help prevent the build up of fluid in your tummy and also help if your blood results are not within the normal range. You should try and keep your fluid intake to ................. mls per day for ............. days. You have no fluid restriction in place. Approximate measures in common drinks Mug = 250mls Cup = 150mls Pint Glass = 568mls. See label on cans and bottles for individual drinks mls.

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What medications we could use to help you Laxatives People with cirrhosis can sometimes develop problems with their brain function (Hepatic Encephalopathy). Hepatic encephalopathy can be experienced in liver disease. It can cause changes in thinking, behaviour, and personality. This is caused by a build-up of toxins in the brain of people who have liver disease. This is because the liver is not working as it should by getting rid of the body's waste products. You can feel sluggish and forgetful and other people may notice you are not yourself. Lactulose The main treatment for encephalopathy is lactulose syrup. This acts as a laxative (it helps clear the bowels) and helps remove the toxins that build up in the body when the liver is not working properly. In some cases, other laxatives or an enema may be used. Lactulose doses can be managed by you as long as your bowel movements are at least twice a day. For example, you may need to take an extra dose if you are not having your bowels opened twice daily or omit a dose if you find you are having loose stools. Antibiotics Rifaximin Rifaximin is in a class of medications called antibiotics that are used to prevent episodes of Hepatic Encephalopathy. Rifaximin treats hepatic encephalopathy by stopping the growth of bacteria that produce toxins and that may worsen liver disease. Page 8

Water tablets (diuretics) These are medications that get rid of excess fluid in the body. Spironolactone Spironolactone is known as a water tablet or a diuretic. Spironolactone is the usual, initial choice of tablet for patients with cirrhosis. It helps remove fluid that may build up in the tummy. 50mg a day can gradually be increased to 400 mg if it is needed. Furosemide Furosemide is also known as a water tablet or a diuretic. Furosemide may be used with spironolactone, depending on how effective spironolactone is on its own. Most people will start with a low dose and increase until some of the body's fluid levels are controlled and the fluid doesn't build up. Blood tests You will also need to have regular blood tests to check the effect the water tablets (diuretic) is having on your body particularly the kidneys and the body's sodium and potassium levels. Sometimes the diuretics may need to be stopped if your blood results change too much, although they may be restarted again at a future date.

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Things to be aware of and seek medical advice / attention, for example:- the G.P., Walk in Centre, Nurse Led Ascites Management Team or Accident and Emergency. Tenderness / pain in your tummy. Any bleeding when you open your bowels. Vomiting dark fluid or blood. Increased yellow colour to the skin or in the eyes. Increased confusion. Increased thirst. Extra information sites You may find some helpful information in one of the sources below:British Liver trust www.britishlivertrust.org.uk Alcohol Anonymous (A.A.) www.alcoholics-anonymous.org.uk Local community alcohol support groups (see local directory for details or ask the Nurse Led Ascites Management Team).

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Have you any questions?

Please write down any questions you have below or anything you want to discuss with us.

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Useful contact details Main Switchboard: 01253 300000

If you have any questions regarding your condition you can leave a message for the Nurse Led Ascites Service. Tel: 01253 953393

Hospital Switchboard: 01253 300000

Patient Relations Department

The Patient Relations Department offer impartial advice and deal with any concerns or complaints the Trust receives. You can contact them via: Tel: 01253 955589 email: [email protected] You can also write to us at: Patient Relations Department, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR Further information is available on our website: www.bfwh.nhs.uk

References

This leaflet is evidence based wherever the appropriate evidence is available, and represents an accumulation of expert opinion and professional interpretation. Details of the references used in writing this leaflet are available on request from: Procedural Document and Leaflet Coordinator 01253 953397 Approved by: Date of Publication: Reference No: Author: Review Date:

Medicine Management 15/10/2015 lc00009397 PL/747 (v2) Julia Gasser 01/10/2018