Advanced Liver Disease Treatment in Israel
Cirrhosis (severe scarring of the liver), as advanced liver disease means that the liver can no longer perform its normal functions. This causes ascites, an abnormal build-up of protein-containing (ascitic) fluid within the abdomen. Without regular frequent invasive needle punctures to drain the accumulated fluid, patients suffer the negative effects of a very large abdomen. However, Prof. Ziv Ben-Ari, Director of the Center for Liver Diseases and of the Liver Research Laboratory at the Sheba Medical Center has introduced to the hospital the new breakthrough alfapump® system. This unique technology negates the need for needles, external tubes and repeated invasive procedures, ensuring that patients at Sheba enjoy a better quality of life.
Causes and risk factors for ascites
Ascites can be caused by many disorders but the most common cause is chronic (long-lasting) liver disease caused by cirrhosis. It most commonly results from portal hypertension: high blood pressure in the portal vein that brings blood from the intestine to the liver.
Risk factors for ascites resulting from portal hypertension include:
- Viral hepatitis
- Consumption of large amounts of alcohol.
Ascites may also result from other liver diseases such as:
- Severe alcoholic hepatitis without cirrhosis
- Chronic hepatitis
- Budd-Chiari syndrome caused by an obstruction of the hepatic vein
Less common causes of ascites include disorders unrelated to the liver:
- Cancer
- Heart failure
- Kidney failure
- Pancreatitis (inflammation of the pancreas)
- Tuberculosis
Symptoms
In case of ascites, massive amounts of fluid in the abdomen can cause:
- Abdominal swelling (distention) and discomfort
- Tautness of the abdomen
- A flat or pushed out navel
- Loss of appetite due to pressure on the stomach
- Shortness of breath due to overpressure on the lungs
- Ankle swelling
Complications of ascites
Spontaneous bacterial peritonitis (infection of the ascitic fluid that develops for no apparent reason) sometimes occurs. This infection is common among people with ascites and cirrhosis, especially alcoholics.
If spontaneous bacterial peritonitis develops, symptoms will include:
- Abdominal discomfort and sensitivity
- Fever
- Confusion
- Disorientation
- Drowsiness
If left untreated, this infection can be fatal. Survival depends on early treatment with the appropriate antibiotics.
Diagnosis
- A doctor’s evaluation
- Sometimes an imaging test such as ultrasonography
- Sometimes analysis of ascitic fluid
When a doctor taps (percusses) the abdomen, the fluid makes a dull sound. If the abdomen is swollen because the intestines are distended with gas, the tapping makes a hollow sound. However, a doctor may not be able to detect ascitic fluid unless the volume is about a quart or more.
Treatment
The basic treatment for ascites is a low-sodium diet. If this diet is ineffective, special drugs called diuretics can also be prescribed. They make the kidneys excrete more sodium and water into the urine so more fluid is expelled by urination.
If ascites becomes uncomfortable or makes breathing or eating difficult, the fluid may be removed through a needle inserted into the abdomen. This procedure is called therapeutic paracentesis. However, the fluid tends to reaccumulate unless patients also follow a low-sodium diet and take a diuretic. This means the procedure needs to be repeated every 7-10 days by draining 8-10 liters of accumulated fluid each time. Because a large amount of albumin protein is usually lost from the blood into the abdominal fluid, albumin may also be given intravenously.
If large amounts of fluid accumulate frequently or if other treatments are ineffective, more drastic treatments are required including a portosystemic shunt or even a liver transplantation, both of which have a high risk of severe side-effects.
Such invasive procedures are now avoided at Sheba Medical Center by the introduction of the most advanced currently available treatment solution, the alfapump® System. This is an innovative pump that is implanted under the skin via a simple surgical procedure that can be performed under an hour via local or general anaesthesia. The alfapump® system collects ascites as it forms and moves it into the bladder, where it is passed naturally from the body through normal urination.
Once implanted, patient interaction with the alfapump® System is minimal. The pump operates continuously 24 hours a day and the physician can personally program the volume of fluid being pumped for each patient. The alfapump® can be charged wirelessly through the skin by holding a hand-held charging device over the alfapump®. The pump loads and transmits online drainage data, which is monitored by a control center and sent via email to the physician. The doctor can then program the rate of fluid transfer and the timing of its extraction from the abdominal cavity to the bladder. This is very convenient to patients, since there is no need for regular hospital visits or invasive paracentesis needle procedures.
At Sheba, we strive to provide the highest quality of life for our patients through the expertise and experience of our medical teams and through employing the latest state-of-art technologies, such as the alfapump® System.
