Hepatitis B virus, hepatitis C virus, alcoholism, schistosomiasis and many other causes can lead to cirrhosis by causing chronic liver disease. In the advanced decompensated stage, patients often develop ascites (commonly known as “hepatic ascites”), or bleeding from ruptured esophageal varices, or hepatic encephalopathy (hepatic coma). In the decompensated stage of cirrhosis patients, in addition to actively seeking regular medical treatment, the correct diet and living is also very important. A. The diet of patients with cirrhotic ascites Patients with cirrhotic ascites often have a growing sense of abdominal distension, the number of urination during the day decreases at night, but the total amount of urination per day decreases significantly, while the weight increases rapidly at a rate of about 1 pound per day. The patient’s abdominal circumference increases rapidly, the abdomen bulges, the abdominal wall is tense, or the abdominal wall bulges out to both sides of the body when lying down, shaped like a frog’s stomach, which is called “frog-like abdomen” in medicine. In patients with severe ascites, the veins of the abdominal wall are exposed, and the navel becomes flat and no longer sunken or even protrudes outward. It can be accompanied by edema of the ankle or calf or even thigh, and the local skin is taut and shiny, which can leave depressed fingerprints when pressed by fingers. Patients with large amount of ascites or ascites combined with pleural fluid will feel tightness and shortness of breath in the chest. First, the patient should measure the abdominal circumference regularly every day. Patients lie supine and read with a soft ruler around the umbilicus for a week. If the urine increases, the abdominal circumference gradually shrinks, suggesting that ascites is receding, and vice versa if the increase in urine is not obvious, suggesting that treatment measures must be strengthened. However, abdominal circumference is easily affected by intestinal distension, so the patient can also weigh regularly every day, which has the same meaning as measuring abdominal circumference, but more accurate. Second, the patient should measure the daily urine output. If diuresis is effective, the daily urine volume should generally be more than 1500 ml, and too little urine volume suggests the need to strengthen the diuretic; if the daily urine volume exceeds 2000 ml, the doctor should be informed in order to reduce the dosage of diuretics appropriately. It is worth noting that temperature can affect the amount of urine excreted. In hot summer weather, patients excrete more water through sweat, and urine volume can be reduced accordingly. Third, flat rest. Patients with ascites should usually rest, stand less and lie down more. When a person in a sitting or standing position, because of the relationship between gravity, the lower body venous system accumulates more blood, not involved in blood circulation. When lying down, the influence of gravity on blood circulation decreases and the amount of blood returned to the heart increases significantly. As the effective blood volume involved in blood circulation increases, the body will promote the excretion of retained water and sodium from the kidneys to reduce the excess effective blood volume through a series of signal feedback regulation systems. The posture of the body is an important reason why patients with ascites urinate more at night than during the day. Therefore, we advocate that patients should rest in a foot-high (higher than the level of the heart) supine position more often during the day, and then gradually increase the amount of activity after the ascites has significantly decreased. Fourth, reduce the intake of sodium. Sodium retention in the body is an important pathological mechanism for the formation of ascites, so it is important to limit sodium intake, which is generally considered to be no more than 0.5g of sodium (1.25g of sodium chloride) entering the body daily. Sodium restriction does not only mean eating less salt, it includes both eating and medication. In addition to controlling salt added to dishes and salt-containing condiments (salt-containing MSG, soy sauce, etc.), any food containing sodium salt, edible alkali or baking soda (sodium bicarbonate) is under control, such as bread (sweet bread also contains a lot of salt), cookies or cakes (containing baking soda), cut noodles and some other alkali-containing pasta products, carbonated beverages such as cola and soda, pickled products, sauces and cooked vegetables. Some patients are very uncomfortable with a diet with little or no salt and have difficulty swallowing meals. You can dissolve salt equivalent to the volume of 2-3 sesame seeds in 1 tablespoon of water at mealtime and season it by dipping the chopsticks into the salt water and licking it. Clinically, avoid or reduce the use of saline and sodium-containing drugs. When large amounts of sodium-depleting diuretics are used, they often cause electrolyte disturbances, and excessive sodium excretion can lead to hyponatremia, when the intake of salt should be properly opened under the guidance of a doctor, and sodium chloride or monosodium glutamate should be given if necessary. Because the retention of water in the body is too much and exceeds the retention of sodium, the sodium content in the blood is relatively insufficient, which is medically called dilutional hyponatremia. At this time, in addition to proper supplementation of sodium, the intake of water should be restricted and attention should be paid to supplementation of potassium salt. Fifth, restrict drinking water. There are still different views in the medical field on whether to restrict water intake in patients with cirrhotic ascites. We generally do not restrict the intake of water for patients with early ascites. For patients with massive ascites and severe hyponatremia, we advocate drinking no more than 1 liter of water per day (including tea, soup and medication) to control the growth of ascites and correct hyponatremia. Some patients think that green tea can be diuretic and drink a lot of it, not knowing that this may aggravate ascites. There are also patients with unbearable thirst and afraid to drink water, you can let them gargle with water to relieve symptoms. Sixth, the appropriate diet. Patients should eat more fresh vitamin-rich leafy vegetables and fruits, bananas are rich in potassium ions, appropriate to eat more can replenish the potassium lost due to taking diuretics. Various kinds of meat, fish and eggs can be eaten, but the number of each meal should not be too much while the variety of fancy is better, so that it is conducive to the absorption of nutrients. In the society, there is a saying that chicken and sea fish are “hairy” and can cause illness if eaten. But seafood contains more sodium than river food, should be moderate. Seventh, the inappropriate diet. Commercially available products, semi-finished dishes, because they contain salt should not be eaten. Soybean products are easily flatulent when eaten and should be avoided. Considering that patients may be accompanied by esophageal varices in the fundus, they should avoid coarse, too cold, too hot and acidic and alkaline food, and should swallow in small bites. Eighth, use less health products. Ginseng or American ginseng have hormone-like effects that can aggravate the accumulation of water and sodium in the body, which is not conducive to the elimination of ascites and should be prohibited. Cordyceps has the pharmacological effect of regulating immune function and anti-cirrhosis, and can be taken in small amounts. Patients with a red tongue can take some maple dong to nourish their yin. Remember that after digestion and absorption of any food or medicine, it has to be metabolized and transformed in the liver. If the liver is sick, the patient then eat a lot of health food or some dual-use Chinese medicine with inaccurate effects, it will increase the load on the liver in vain, as if a person who usually can only carry 100 pounds of burden is seriously ill, we do not let him rest, but also force him to carry 150 pounds of burden. Therefore, my view is that patients with liver disease should take as little health care products as possible, and patients with cirrhosis should do even more. Patients with cirrhosis at the beginning of ascites, do the above eight, often without taking diuretics ascites will gradually subside. And many times ascites patients, take the above measures with the doctor’s treatment, more can enhance the effectiveness of treatment. Second, the esophageal varices of cirrhosis patients’ diet and living Patients with cirrhosis due to liver microcirculation disorders, blood stagnation in the portal vein system, resulting in increased portal vein pressure, resulting in portal hypertension, can cause esophagogastric varices, easy to rupture and bleeding. For patients with cirrhosis whose esophagogastric varices have been confirmed by gastroscopy, whether or not they have ever ruptured and bled (black stool, vomiting blood), in addition to active treatment to prevent bleeding, they also need to pay great attention to their diet. First, avoid food irritation to the esophagus and stomach. Patients should not eat acidic, spicy and other irritating foods, or cold or hot foods, so as not to stimulate the varices to dilate or contract, resulting in increased pressure in the blood vessels and causing bleeding. Secondly, avoid the abrasion of food to the esophagus and stomach. The mucous membrane on the surface of varicose blood vessels is delicate and easily broken, causing bleeding. Therefore, you can not eat directly into the rough things, such as nuts, celery, bamboo shoots, oranges, etc.. If you really want to eat, peanuts and other nuts can be ground into a pulp, vegetables and fruits can be juiced. Even the softer and smoother food, it is also appropriate to swallow in small bites. Do not accidentally swallow bones and fish spines! Third, avoid increasing the pressure on the esophagogastric fundus vein. Severe coughing, proto-toilet struggle, may increase the pressure in the blood vessels, should seek medical help to stop coughing or laxative. The air pressure in the cabin changes significantly during aircraft takeoff and landing, and the fluctuation of air pressure may bring about an imbalance of pressure inside and outside the varices, causing bleeding. I had a patient with cirrhosis of esophageal varices on a business trip in China. He drank a glass of iced Coke and ate a packet of peanut rice during the flight, and soon felt discomfort in his stomach. He was diagnosed with a ruptured esophageal variceal hemorrhage. Fortunately, he got medical attention in time and saved his life. Since then, he remembered the lesson of blood, and with active medical anti-liver fibrosis treatment, he has not had any further bleeding for several years. Three, cirrhosis with hepatic encephalopathy tendency of the patient’s diet and living. Hepatic encephalopathy, also known as hepatic coma, is often caused by elevated blood ammonia concentration or other complex factors. Through comprehensive treatment, hepatic encephalopathy can be clinically cured. However, to prevent the recurrence of hepatic encephalopathy, in addition to medical treatment, the patient’s self-care also plays a pivotal role. First, the choice of protein and the right amount. In the past, patients with hepatic encephalopathy should choose a high quality, low protein diet, i.e., eat small amounts of protein from animal sources. But decades of practice have shown that this is a misconception. During an attack of hepatic encephalopathy, a protein diet should generally be prohibited, but as the disease goes into remission, the protein diet can be gradually increased until it is about 50-60 grams (2-3 taels) per day. Although strict restriction of egg intake can prevent elevated blood ammonia, it can further worsen the patient’s nutritional status, aggravate liver damage and increase the risk of death. The choice of protein type should be based on plant protein, followed by milk protein. There are many advantages of consuming vegetable proteins, which will not be repeated here. Animal proteins, which have the strongest encephalopathogenic effect, should be avoided as much as possible. Second, keep your bowels open. Toxic substances that cause hepatic encephalopathy mainly come from the intestinal tract, so it is important to cleanse the intestinal tract to reduce the production and absorption of ammonia and other toxic substances to prevent and treat hepatic encephalopathy. Doctors usually use bowel-cleansing medications, and patients should not skip taking them because they are tired of going to the bathroom more than once. The important thing to remember is that it is better to have diarrhea 2-3 times a day than to have 1 bowel movement in 2-3 days. Third, do not overuse diuretics. Patients with ascites are often in a hurry and take diuretics in high doses leading to electrolyte disturbances and inducing hepatic encephalopathy. In addition, family members should pay attention to the patient’s demeanor and thinking reactions, as soon as there are abnormalities, should seek medical attention as soon as possible.