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Avatar universal

Ascites as first symptom, Dr. Appt tomorrow

Hi everyone,

I have never had any symptoms of Cirrhosis until very recently. I know I have gained weight recently due to not excessing and eating poorly but started working out and noticed I wasn't losing any weight or belly size. Then my belly seemed to be getting bigger. Finally this last week I started thinking that I had a hernia behind my belly button because I saw some puffiness there. Since then it seems to be picking up steam and I keep thinking how much bigger can I go. I looked up some stuff online and found out what Ascites was and it really sounds like a match to what is happening to me. I feel so bloated and I don't want to eat because every time I do I feel even worse and feverish...it really feels better not to eat. Also, despite not eating much...my weight is staying the same which seems to suggest accumulation of fluids.

I seem to be experiencing many of the classic symptoms of Cirrhosis other than the Ascities, although I don't feel like eating due to how full I feel and how I know I will feel afterwards.

Additionally, I have been treated for high blood pressure and just changed medications recently but the belly button expansion thing had begun prior to that change so I don't think it is related. My doctor wanted me to wait 5 days to make sure it didn't get better after I was used to the new medicine but I don't feel like I could make 5 more days expanding so I urged him to let me come in tomorrow.

In the end, I am showing a couple symptoms of Cirrhosis and a couple for Cogestive Heart Failure on the right side.

I guess I am wondering if this sounds familiar to anyone in their beginning stages. Any responses are appreciated.
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Avatar universal
what are your symptoms exactly?
normally bloating should normalise within day.
do you stay bloated for many days?
bloating may be due to bowel problems, not ascites.
Helpful - 0
Avatar universal
Thanks for your reply.

Currently the most bothersome symptom is the bloating. Other than that I would say...
1. Tightness around my head near my ears and ringing.
2. Shortness of breath when walking (This might be the new BP meds)
3. Rapid heart rate (My Dr thinks this is new meds as I came off atenenol which keeps heart rate down and am now on linsipril)
4. I feel like I have dark bags under my eyes for the last couple weeks and dry eyes.
5. Don't feel like eating because the bloating is so much worse and I actually feel feverish for a couple hours after eating. I will be having fruit/veg juice until my appt.
6. I have had digestive issues for a while but doctors never thought it was anything to worry about. I have been looking at Crohns or Ulcerative Colitis as possibilities too.

I don't have jaundice skin or eyes

I haven't had weakness, I lift weight in the gym and had been strong as much as ever

No increased bruising or bleeding

I have previously been diagnosed with fatty liver but it appeared to be a med that caused it and my liver numbers went back to normal range.

I do have a history of drinking heavily so I worry mostly about Cirrhosis as it seems logical.
Helpful - 0
Avatar universal
Oh and in addition to dry eyes, I seem to have semi-dark circles under my eyes for the last couple weeks to a month
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Avatar universal
Oh and based on your question. The bloating does not get better, it appears to continue to expand despite hardly eating anything. This is based on puffiness within my belly button pushing through and feel. When I eat it is almost unbearable.
Helpful - 0
9662954 tn?1405606159
Have you been properly tested? If you have confirmed cirrhosis, ascites can make you feel bloated, sleep cycles get out of whack, constipation will be an issue, and you might have portal hypertension which def causes all of this and reacts to high blood pressure.

So: confirm cirrhosis diagnosis along with  esophagus exam and portal hypertension. If all that is confirmed, then you have several treatment options: antibiotic for gut, lactulouse, banding of esophagus if necessary, liver friendly diet which means no drinking and no salt, no red meat, no processed foods, etc. possibly an antidepressant? Liver disease can make you, constipated, anemic, sleep deprived, pain, swelling, confusion, ascites with a possible infection.

Please read this pdf:  www.med.umich.edu/1libr/hepatology/CirrhosisToolkit.pdf

This will explain everything! It helped me a lot!

Good luck, dbzc
Helpful - 0
Avatar universal
Thanks Dbzc2. I am going to see the doctor tomorrow. Just based on my symptoms and logic, I imagine that Cirrhosis could be a reality.
Helpful - 0
9662954 tn?1405606159
Wait til you look through that PDFs link I sent you. Hector sent it to me. It was a Godsend! I have cirrrhos but only got it recently. When I went through that "toolkit" I finally had most all of my questions answered!

It talks about all the symptoms what they do and what can be done. The second half is a great journal of drugs and weight etc...for you to report to each visit and then record next plan.  I highly recommend you read it and if you can share a copy with your doc.  That's what I did and he was thankful.  I'm just so thankful to Hector for getting it to me!

Good luck!  Dbzc
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Avatar universal
Thanks man, there is a lot of solid information in there! I am hoping for the best tomorrow in my appt and hope I don't actually have it obviously. But I am prepared for it and have information already.
Helpful - 0
Avatar universal
May I ask how old you are?
If your worried, going to the Drs tomorrow and getting it checked out will help clear your mind.
The symptoms you described, along with normal bloodwork do not indicate Cirrhosis.  If you could expand on your background I may be able to help you with these concerns.
Hope to hear back.
.....Kim
Helpful - 0
Avatar universal
Thanks Kim.

I am 39 years old. I have consumed alcohol slightly to heavily and for some long periods of time abstaining from 25-39. I am not a person that would drink all day or anything but I might have a heavy night and take two nights off, then a light night. Sometimes a couple events like football games in a row.

I have been treated for high blood pressure for about 4 years with atenenol at 50mg.

After recently really enjoying going out with the boys too much and drinking at home coupled with eating out a lot, I found that I had gained some weight. Generally in moderate shape, I am about 190. After starting a new job working from home and the above behavior of eating poorly and drinking, I found myself at about 215. About a week ago, I saw that the inside top of my belly button was puffing out a bit at which point I thought, ok I need to workout and eat better. So this last week I had been doing cardio and weights again while eating well and I am noticing that the belly button keeps pushing out further and my belly appears and feels fuller everyday. Since last night I really don't want to eat anything because every time I do the fullness seems unbearable for an hour or two. Also, after eating solid food I feel feverish. Also it is hard to sleep on my side with how bloated I feel.

That said, my doctor just switched my blood pressure medicine 3 days ago. He is thinking that this is the reason for the bloating and was minimizing it but this seems way to extreme to be normal bloating and from reading sounds like Ascities.

You are right on their being different reasons for Ascities but from reading about it, I was rattled to find out that by far the most common cause was Cirrhosis and it seemed to match due to examining my drinking. But then again, my mom and dad drank pretty well into their 50-60s so there is no history of it. There is however history on both sides for high blood pressure.

I guess another possible cause of this based on my history could be Congestive Heart Failure specifically on the right side of the heart based on my symptoms.

I am just freaking out by the unknown. I guess I should just calm down and wait to hear tomorrow.

Does anyone know if they can drain the fluid the same day? How long does it take to get tests back for urgent issues like this? If this is Cirrhosis would you expect them to admit you right then and there or they have to fumble around figuring out what it is before helping you?
Helpful - 0
Avatar universal
did you have your appointment? what did the doctor say?
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Avatar universal
I just got back from the doctor and here are the findings.

1. The belly button bulge is a hernia apparently. This was exaserbated by the bloating. They won't do anything about this unless there is pain or a problem.

2. He thinks that the bloating was caused by the new medication. He switching the medication to a different one.

3. The bloating is not bad enough for him to consider it Ascities even though to me it feels very uncomfortable.

4. Due to the fact I previously had been diagnosed with a fatty liver, I am getting tests done on that still.

All I can say is I was seriously freaking out yesterday and this is pretty good news at this point. I am still curious about the liver test coming back. After doing research and reading about Cirrhosis, I am really going to adjust my lifestyle regardless of how the tests are.
Helpful - 0
Avatar universal

interestingly, i  have bloating problems and ringing ears.
my bloating is simply air wind. I wonder whether the ringings ears are associated with the bloating. Maybe, bloating is causing pressure and in turn this may cause ringing ears or pressure in the ears.

My liver enzymes normalized (I had fatty liver also). One month ago
I did an ultrasound and yesterday I did an ultrasound with doppler and they were normal for liver, spleen, blood flows from liver, portal vein, splenic vein, etc. However, still I am not sure if I can exclude cirrhosis for myself.
Today, I woke up with my left hand upper limb swollen. I did not  understand  if this is related to liver or not. I went to my family doctor and he pressed on my hand and said there is pain just in a local region which means the tendons in that part are damaged and that is the cause of swelling. I am still suspicious about it...
Helpful - 0
Avatar universal
That sounds kinda weird. How is your blood pressure?

I was on atenenol 50mg and didn't realize it but I had swelling going on the entire time. I got heavier too which didn't help but at some point, I couldn't put on my wedding ring anymore. The day I started taking Linsipril that went away and I could put it on immediately.

So strangely, I did have swelling in my hands but went to my belly after switching meds. On the new medication, I did have the ringing of ears and pressure also which is why I asked about that.
Helpful - 0
Avatar universal
when i was at doctor one week ago, blood pressure was normal.
today, i forgot to check it. however, i have pain in my left chest from time to time and recently. i was in a cardiologist a few months ago, but ekg  was okay. at time time, he told me that my heart is beating a little bit fast.
Helpful - 0
10805050 tn?1420935520
Hello...

Sorry to hear you're not feeling well.  I have suffered basically every life threatening symptom of Portal Hypertension, and will try to share my experience and perhaps help you get an understanding of how far reaching this problem actually is.  I have bled out twice to the point of having to be hit with the paddles and put on a mechanical life support ventilator.  Both times it was acute portal hypertension causing (1. a 2cm x 2cm Mallory-Weis Tear and (2. 10 varices veins burst in my esophagus. Both times I went into Hypovolemic/Transient Shock do to sudden massive blood loss.

I suffered from Acites for months on end requiring me to go to the Hospital's Interventional Radiology twice a week for Paracentesis (removal of the abdominal fluid with a large needle guided by ultra sound).  One time they drained 12 liters, the max the machine could take. All of this was a direct result of Portal Hypertension.  The increased pressure squeezes fluid thru the membranes of your organs into your abdomen, and the backed up pressure transfers next to the veins surrounding your esophagus causing Swollen or Ruptured Varices.  

I later had a TIPS (Transjugular Intrahepatic Portosystemic Shunt) placement procedure, bypassing a large amount of Portal Vein blood past the liver and Hepatic vein.  This limits the amount of blood to the liver from the GI track, hence relieving the Portal Hypertension.  This is a dangerous procedure with a pretty tough 90 day mortality rate taking prior bleeds into account.  It is normally done to hold you over for transplant. And, unfortunately a side effect of the procedure is Hepatic Encephalopathy (Ammonia Toxicity).  

  With increased Portal Pressure fluid loss to the abdomen and an injured liver not properly synthesizing proteins and/or not cleaning toxins as it normally would, you experience all kinds of chemical imbalances affecting many systems.

   It does not properly supply red blood cells with clotting factors (Thrombocytopenia) - In turn your Prothrobomin Time (Time it takes your blood to clot) increases, greatly affecting your INR number and MELD score.  This "Thin Blood" and increased pressure causes nose bleeds, minor cuts that just keep bleeding and the red spots and spider veins on your skin. In a worse case when mixed with portal hypertension it can cause massive bleeding in the GI track which is extremely hard to control.

   Your liver leaks out Bilirubin (a waste product) into the blood because it is not properly producing Albumin, greatly affecting your MELD score. This retards production of Creatinine (again upping you Meld score) in direct correlation to your Raised  ALT Enzyme.

3.  Your liver does not break down all of the Ammonia (your GI track creates during digestion)  into Urea (A non-toxin waste the kidneys can pass) The Ammonia (a toxin) instead goes to your muscles to break down some. That's why it is SO important to get some type of exercise (No matter how small at first) so your muscles don't waste. Because whatever Ammonia is left in your blood stream passes the Blood/Brain barrier causing Hepatic Encephalopathy (Ammonia Toxicity) You may become forgetful, clumsy, display poor hand righting and so-forth. It can become very severe if not address.  Lactulose (a strong Non-soluble Sugar base laxative) keeps your GI Track passing foods quickly before they build up too much ammonia.
  
4. A fast moving GI track combined with Decreased Absorption by the liver causes Hyper-Metabolism. That's why they recommend 6 small meals a day rich in Fruits, Veggies, Fiber, Carbs and Non-Meat Proteins. I still eat a meat entre at dinner time every day, I just watch how much and how often.  I also take Xifaxan which is an antibiotic that complements the efforts of the lactulose very well. The combo works great to reduce my symptoms of Hepatic Encephalopathy.

  Your Renal System relies on the liver to maintain proper metabolism.  The most important being a proper balance of Sodium and Potassium.  Most people have too much sodium and not enough potassium, greatly affecting your metabolism. I eat a NO SALT diet and take a potassium supplement (as prescribed). Chronic Low Potassium (Hypokalemia) causes Tachycardia (Irregular heart rate) as potassium regulates your heart beat rhythm . That may explain your heart problems.

Also, people suffering Cirrhosis can develop Kidney problems and many suffer Renal Failure requiring dialysis due to an imbalance their chemicals.  I treat it with a strict diet of whole fresh foods, tons of fruits and veggies (Dark leaf is really good for this) and I seek foods that are naturally high in potassium and NO SALT. It has served me well and every time I have blood work done my MELD score decreases.  I credit most of the improvement in my condition to DIET. In fact, I went from a Decompensating  Liver to a Compensating Liver Function and dropped my MELD Score from 24.4 to 7.  I am no longer on the Transplant list.

The only thing I don't understand is your cuff blood pressure. Usually if you have a problem with Portal Hypertension, the Portal Vein pressure is dramatically increased and, in turn, your cuff blood pressure is very low... like 100/65 or lower.  You will normally have a high resting pulse as well... like 90 or greater.

The best recommendation I could make to you is to see an Interventional Radiologist (Usually their own Dept. in a large hospital).  The will preform an Abdominal Ultra Sound which will definitely show any pockets of fluid. If large enough they will preform a Paracentesis Procedure (which I found to be no big deal) and drain the fluid.  

If you have repeat and often Ascites requiring Paracentesis they may evaluate you for a TIPS procedure. During the evaluation they will do a Transjugular Hepatic Vein Wedge Pressure Test, which is a same day surgical deal. If the pressure is too great, along with other secondary conditions, and warrants correction they may recommend a TIPS procedure.  But try to nip all this in the bud with proper Diet, Exercise, Medication and No Alcohol.

You do not want to have Portal Hypertension turn into a major Secondary Condition to Cirrhosis: with Ascites, SBP, Varices Veins swelling and possibly bleeding, and the like.


  If you are using salt you upset your Potassium/Sodium Balance and Retain Fluids, and in turn increase the likelihood of Chronic Ascites. I take Lasix (Furosemide) and Aldactone (Spironolactone) as diuretics .  Aldactone specifically hold on to your Potassium so you don't lose it thru urination. And I drink Water from sun up to bedtime to let the kidneys flush as many toxins as it can.  Believe it or not, Urine is the densest fluid in the body, chemically speaking.

A further complication of build-up Ascetic Fluid can cause SBP (Sudden Bacterial Pancretesis) were infection results from the different fluids and toxins building up in the abdomen.  If you go in for Paracentesis they will first test you for this by drawing a small amount of the fluid and analyze it.

I only hope you seek and find a GOOD Interventional Radiologist (Preferably an IR Surgeon) and treat the Ascites as best as you can now, to avoid the future problems it can cause. I've never written so much before, but I wish someone had pointed out these interactions to me when I was going thru Chronic Ascites. The TIPS procedure worked for me. But I have to say, when I was going thru it I trusted my Doctor, because at the time I really didn't know what was going on. I hope this was helpful and I wish you the best.

Andy  
Helpful - 0
10805050 tn?1420935520
P.S. I would imagine everyone on this website has ringing in their ears. I wish I had an explanation for it. I've just gotten used to it.  In perspective, things could be a lot worse than that constant Rinnnnnnnnng in the ears. I've written it of as "just one of those things".  I hope all goes well for you and everyone.

Andy
Helpful - 0
Avatar universal
Well, good news so far.
I kinda expected it may have been a hernia but not knowing your age, did not want to speculate.  Hopefully upon further testing you will get some answers.
Congestive Heart is unlikely unless you have other ailments that would point to your heart.  Typically this is a disease of people over 50, but not always.

Have to say I'm happy that you are addressing your drinking.  As you can tell by other posters its a lousy disease to get.  The good news is that its totally avoidable with cutting back or stopping drinking all together.  It's human nature to think that it won't happen to us, but alcoholism has a tricky way of sneaking up on us sometimes when the damage done is irreversible.  Would hate to see that happen to you.

Please keep us posted on your upcoming results.  Was outta town for a few days and offline when you responded.  Sorry about not getting back sooner.  We have all been affected by alcohol either directly or indirectly in our lives. We will be able to help you decifer the maze of Cirrhosis or other questions and concerns.
Take care
....Kim
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Avatar universal
Andy, no doubt your hands became tired from typing...however that was a brilliant and MOST helpful summary...Many, many thanks!!
PD
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Avatar universal
Thanks Kim. I did hear back about my liver tests and they were elevated. I am getting additional tests today. I am hoping that this is just a case of the heavy drinking as a temporary problem and not a indication of a permanent issue.

I believe that said my AST was about 300 and the other was 100 which sounds pretty bad.

I am going to keep staying away from alcohol and eating very clean. I am considering milk thistle and some other supplement. What do people think about these?
Helpful - 0
10805050 tn?1420935520
Hello Again,
I promise I won't write another book.  Liver Enzymes have a funny way of jumping up and down, and you are correct in that it can be a temporary raised level.  The are normally looked at over time for just that reason.  If you nip things in the bud, you will most likely be pleased to see how resilient and rejuvenating the liver is.  I take Milk Thistle, and other than a good mega multi vitamin and B12 - those are the only off the shelf meds I take.  I have been pleased with the Milk Thistle. And I swear by a very healthy diet (Something that was totally new to me).  I hope you're feeling better, and wish you the best.
Andy
Helpful - 0
Avatar universal
So happy that you are following thru on this situation.
I am in 100% total agreement with andyhawaii. I also take Milk Thistle and a good multi-vitamin.  The B 12s are included in my regimen as well.  I do have early cirrhosis and feel that probiotics are essential for digestion and they have curative effects for most diseases.  Vitamin D is known to help the immune system and is often found to be low in alcoholics.  A little sunshine a day can also protect Vitamin D deficiencies.
Keep us posted on your next set of labs.  Between Andyhawaii and myself we can give you a good idea of where your at in regards to your liver health.
Stay well
.....Kim
Helpful - 0
10805050 tn?1420935520
I agree with LiveLife. Probiotics are an important step in the puzzle as the whole GI system is greatly effected by Liver problems.  What happens is your immune system is being taxed in a dozen different directions and the Nasty Flora are very opportunistic. The only reason I didn't list it is I had just finished a 90 day 20billion flora per day Probiotic treatment in Sept. and my Dr. said give it a rest for a while Andy., so I took time off in that treatment.  And for those out there taking Lactulose...Nasty Flora can dig in, so I would recommend a High Count Course of Probiotics for a reasonable amount of time. You can follow up with 1-3 Billion count thereafter if your Dr. agrees.  Never forget to tell the Doc about all over the counter drugs and Proprietary Blends.  I was taking Calcium for my anemia, only to find out it blocks the absorption of Iron, boy did I feel Dumb! Best Wishes,  Andy
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Avatar universal
Thanks everyone. I am still awaiting extra test results and then I imagine I might get a scan delay done.

I totally agree with the idea of eating and living well. I have been doing the mean green juice recipe which consists of apples, cucumbers, celery, ginger, kale and lemon. I am having two of these a day and any meal I am having is non-processed foods, lean meats and all kinds of things with antioxidants. I looked up a bunch of power foods for the liver and have been making sure to eat those. Garlic, green tea, leafy veggies, olive oil, etc.

Also, while eating like this and working out...I should be losing weight also which I am told is a good strategy too.
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