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Authors: Nicoleen Mae D. Sibayan, Kate B. Smith, Aulyn B. Tanacio, Hannah Lhyne O. Tayab,
Rosana L. Tianza, Abelyn C. Tio-tio, Kendra B. Tiwaken, Jazzyl Keth S. Tongab, Krista Dee D.
Wagawag, Sharalina C. Walisen, BSN IV

Keywords: Decompensated, liver, hypertensive Cardiovascular disease in HCIIC, hemorrhage

Overview of the Case: Patient Bvm’s condition started two years ago, when patient underwent
repair of inguinal hernia and angiography due to infection with emergency evacuation of
scrotal hemorrhage few days after first surgery. Since then, patient noticed increasing
abdominal girth with associated oliguria and urinary frequency. Six months prior to admission,
patient’s symptoms persisted that urged him to seek consultation at the Out Patient Department
(OPD). Parenthesis was done to decrease fluid accumulation in the abdominal area that
provided a temporary relief. One week prior to admission, complaints of haemorrhage in scrotal
area then sought consultation in our institution and testing was done. However sudden
movement of the patient increased bleeding and stitching was done. This prompted patient to
seek consultation for further evaluation and management.

Abridged Drug Study: Treatment was given such as Lactulose to treat constipation and help to
eliminate ammonia in the blood via the stools to prevent hepatic coma encephalopathy.
Tramadol is given also to manage the client complaint of severe pain. Spironolactone is given
since aldactone removes excess fluid from the body in congestive heart failure, cirrhosis of the
liver, and kidney disease. It also can be used in combination with other drugs to treat
elevated blood pressure, and for treating diuretic-induced low potassium (hypokalemia).
Laboratory test such as Complete blood count (CBC) may be ordered to evaluate a patient’s
red and white blood cells and platelets; anemia may be present if bleeding has occurred, and
platelets are often decreased with cirrhosis. Alanine aminotransferase (ALT) is an enzyme found
mainly in the liver. Values are increased with all types of liver injury, including cirrhosis. Alkaline
phosphatase (ALP) is an enzyme found along bile ducts. ALP is usually normal or mildly elevated
in cirrhosis.

Course in the by Ward: January 27, 2019: Patient is a known case of massive ascites secondary
to decompensated liver disease, Hypertensive Cardiovascular disease in HCIIC, accompanied
by his son. The patient was admitted because of persistent increase of abdominal girth
associated with oliguria and urinary frequency. After admission, patient claims to experienced
further increase in abdominal girth, severe pain, and unstable blood pressure. Patient was
showed some signs and symptoms of weakness, cold and clammy extremities.
Conclusions: Massive ascites is a serious condition that needs immediate medical intervention.
The prognosis for patient with ascites due to liver disease depends on the underlying disorder,
the degree of reversibility of a given disease process, and the response to treatment. Ascites
tends to occurs in a long standing rather than in short lived disorders. It occurs commonly in
cirrhosis, especially in cirrhosis caused by alcoholism. It may occur in other liver disorders, such as
severe alcoholic hepatitis without cirrhosis, chronic hepatitis, and obstruction in the hepatic vein.

In the case of patient BVM with liver disease, development of ascites is an important landmark in
the natural history of cirrhosis. Adequate management of ascites is important, not only because
it improves quality of life in patients with cirrhosis, but also prevents serious complication such as
SBP. However, treatment of ascites does not significantly improve survival. Therefore,
development of ascites should be considered as an indication for transplantation. Liver
transplantation is the ultimate treatment of ascites and its complications.

Recommendations: The researchers recommend that the healthcare provider (HCP) be aware
and inform that liver disease is the leading cause of ascites. However, many serious conditions
can lead to the build-up of fluids in the abdomen. It is highly recommended to the patient to
follow the discharge plan given such as promote healthy diet especially sodium restrictions.
Although dietary sodium should be restricted to levels lower than urinary sodium excretion,
sodium restriction to 2 g per day is realistic goal particularly in an outpatient setting. Take
diuretics as recommended by doctors. Patient should limit the use of all medications including
over-the-counter drugs, unless recommended by the doctors. Bed rest is recommended for
patients with ascites on the basis that upright posture increases aldosterone levels, which is
associated with sodium retention.