ascites

[hollyhock123]

My husband was diagnosed with cirrhosis and ascites three months ago.
His abdomen is quited extended and ankles and feet are swollen.  He has a terrible cough and fits of gagging.  He has been on a low sodium diet.  But his condition is not improving.  When I contacted you before you recommended that he see a gastroenterologist.  I requested a referral from his personal physician but he referred him to an internal medicine doctor.  Is this adequate or should we insist on a gastroenterologist?

[Kevin Pho, MD]

Different regions will have different referral patterns.  In most cases a gastroenterologist would be the appropriate specialist, but there are some internal medicine physicians who feel comfortable managing these cases.

If there are breathing difficulties due to the amount of ascites, you may want to consider a paracentesis - where a needle is used to relieve the abdomen of fluid.  A gastroenterologist, internist or interventional radiologist can all perform this procedure.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[LvdByGod!]

hi your husband should be going to a gastro but perferably a hepatologist...he probably needs fluids to be drained and lasix or whatever water retention eliminator drug. the absence of salt is not going to fix the liver problem...only the water retention problem perhaps...has your husband had full testing for liver virus' and other liver problems and complications? has he had a biopsy?

your husband needs a specialist at this time...cirrhosis is serious and life threatening...your dr may not be up to snuff on his knowledge of liver problems and proceedures. you also should be checking for alphafetoprotien and getting regular ct scans,or ultrasounds, blood liver numbers,periodic liver biopsies...

at this point in the seriousness of this disease i would insist on a specialist and perhaps even a liver transplant hospital team...cirhosis can lead to liver cancer...all must be regularly monitored and treated as things come up...you really need someone knowledgable to be able to instruct him as things come up and figure out if there is a treatment for what ever causes the liver cell death...

  insist on a hepatologist or at least a gastrointerologist...

have you tried a cirhosis support group on the web with others in your position? they may be able to further help you...here is an address to punch in and check out...the folks there are very kind and knowledgable. (cut and paste)

http://groups.msn.com/CirrhosisSupportGroup