Cirrhosis Support Group

My husband is plagued by a chronic cough which he has had for many months now. At first, it seemed to be triggered when he ate cold foods. Now it is with him all the time. He is not a smoker. Last fall, he had a bad alcohol-induced fall, broke four ribs, one of which punctured a lung. Of course, we first thought the increased coughing was a product of that injured lung. However, the doctors report his lung seems to be healing quite well; but the coughing persists. Now we're left to wonder if the coughing is somehow related to liver disease. Has anyone else experienced that symptom?

Deanne,

Ascites can cause coughing as the fluid increases putting pressure on the diaphragm.

There is also the risk of increased fluid through out the body.

I would also ask his dr about varices and other irritants to the esophagus.

Cirrhosis patients have a increase in other Gi Problems including GERD (Which can cause cough) Barretts esophagus.

Based on th fact that he had punctured a lung, I'm sure he had blood tests and possibly an MRI to see if any other organ was punctured.

Since the liver sits in part behind the ribs, did they say anything about it?

Was he diagnosed with Cirrhosis or liver disease?

The the blood tests come back normal?

And finally, is it a productive cough? Or a nagging dry one?

Gail: You may be right about the ascites being part of the problem. When my husband was hospitalized after the fall, he was put on heavy doses of Lasix and Spironolactone. He eventually had to undergo paracentesis. Once released from the hospital, he started retaining a lot of fluid again, so the Spironolactone dosage was increased. That seemed to do the trick, and eventally the dosage was decreased and eventually eliminated all together because Jake's blood pressure got too low.

When we went back to the gastroenterologist a few days ago, he thought Jake's belly was distended again. It's difficult to know for sure because I finally have a husband who has regained his appetite, so the extra pounds could be going on because of excess calories. The doctor immediately put Jake back on Spironolactone and was concerned enough that he wrote an order for another paracentesis. When Jake got his ultrasound, they decided there wasn't enough fluid to warrant the procedure. We're still wondering if that was a wise move because Jake's belly seems to be quite distended, an isolated pocket on his left side where ascites has formed in the past is increasing in size, and he is obviously retaining fluid in his legs/ankles. Does anyone know what the criteria is for determining when paracentesis is necessary? I'm sure they would much rather try to control the ascites through meds, but at what point is that not effective enough?

Jake does have GERD and has taken meds for that over the years. He has also had at least two upper GI scopes that show some "irritation" in the esophagus, probably a direct result of his drinking. As far as I can ascertain, though, I've seen no reports of varices. One CT report did mention portal hypertension.

Sammy 566: Jake was diagnosed with cirrhosis last May but did not discontinue drinking at that time. Instead, his response was to avoid all doctors and drink even more than before. It took his fall and two-week hospitalization to "wake him up" to the realization of the damage cirrhosis can wreak.

He was never forthcoming with info about blood tests before he was hospitalized and only then did I take over monitoring and collecting all data. I gave him no choice. I do know his liver enzymes have been out of whack for a long time because he revealed that to me once (in a weak moment) a few years ago. Who knows how long it has been that way.

Jake's cough is more of a nagging, dry one. Every now and then, he is able to bring up some phlegm, but most of the time the coughing is not very productive.

It's so difficult to sort out everything that is going on now to determine what is only temporary and what might be chronic. His lab work seems to be looking better and yet his doctor just said two days ago that Jake has "pretty bad liver disease." I notice that Jake's albumin is still low (3.2) bilirubin, TOT high (1.2), AST high (64). His INR is high (1.59). Some of his blood counts are also being flagged: RBC is low (3.25), HGB low (9.4!), HCT low (28.6)and RDW high (56.7)

As an aside, he was diagnosed with hemochromatosis almost twenty years ago, and I can't help but wonder what part that disease is playing in his current condition. His hemochromatosis has been relatively easy to control since the initial phlebotomies. In face, it's been more than a year since he's needed one. Are we missing something here?

Thank you, Gail and Sammy 566, for your input. If you or any others have additional insight, I would appreciate anything you can offer.

I can relate to the coughing too. My broher and I had that 3-week cold over X-Mas and New Years and he actually had x-rays (clear) and antibiotics - I let mine disappear on it's own. BUT he continued to have a constant dry cough. He was still drinking then (not now - Yeah!!! from my first post on this site) and smoking 2 packs a day. So he went to a doctor who said she really thought he had COPD and it turns out he didn't and doesn't (since got a new doctor - she was really scatter brained). As many of you know Doctors are super proactive if they even remotely suspect COPD. After Detox forced by me and decided by him, the smoking cut in half and the coughing stopped. Now though he's not hungry (anti-depressant side effect she put him on probably) but he's drinking so much milk! 1 and 1/2 gallons a day! Is that dangerous anyone? Sorry I went from subject to subject but the bottom line is as Elizabeth said. Any cough needs a Doctor's attention! Ru

Hi everyone,

I came across this thread/forum/site looking for other information. However this may be of help to someone out there. If you or a loved one is having a dry cough associated with ascites. Get it checked out quickly by the best gastorenterologist/hepatologist you can get to..make sure they have a speciality in hepatology.

My reason for this is as follows: My husband started suffering from a dry, hacking cough a few years ago....constantly getting worse. Talked/visited several doctors and even with his blood pressure being high, we where told that is was because the air is so dry. Try an humidfier, did that with a very small improvement for a very short time. Tried bp meds, they only made his kidneys hurt, was told he just had to get used to hurting...it would go away. NOT, if something makes you hurt, it's God's way of telling you that your body doesn't need it. It's doing more harm than good. Then it would start again. To make a long story short, he suffers with hypothyroidism and is a diet and exercise controlled diabetic.

In the fall of 2012, he develop gross edema and ascites. He was hospitalized in Dec. 2012...which resulted in End Stage Renal Disease being the diagnosis. Still the ascites was not treated or addressed, as we did not have a specialist where we live. After a few months of being on dialysis and deciding to do peritoneal home dialysis. Upon going in for the pd cath placement, the surgeon came out and said we needed to see a liver specialist quickly.

Today, we did just that. Result, he's going in soon for workup's for a liver & kidney transplant. Could this have been avoided, if someone had listen 5+ years ago? Only God knows the answer to that.

My point in this, DO NOT STOP demanding to see a specialist. It's your loved one. Especially when you do not feel the issue has been properly addressed.

Hope this helps,

cricketbass

Hi ama2six,

Does your husband cough more at night while lying down? This could be indicative of congestive heart failure which is not too uncommon in cirrhotic patients. They will have a cough and cough up frothy sputum.

As far as when someone can have a paracentesis depends on how they feel, ie, shortness of breath, decreased appetite. Does your husband lie on his left side more than the right? If so this could account for the bulge or fluid pocket on the left side. His feet and ankles could be swollen due to pressure on the great vessels in the abdomen from the ascites . Congestive heart failure could also cause this. People with CHF have less edema in the mornings because the heart pumps better while they are lying down.

With cirrhosis there is a fine line between being stable and unstable. Get one problem corrected and two more things go wrong. Cirrhotic patients are delicate. Many gp's/internists and some gastroenterologists have not had enough education to manage cirrhosis. Does his gastroenterologist specialize in liver disease? If not, I and others here would suggest getting a referral to a hepatologist.

Some other possible reasons for cough:

Sinus drainage

Pressure of the ascitic fluid(ascites) against the diaphragm

It is possible for the ascitic fluid (ascites)to move from his abdominal cavity into the lung space if there is a defect in the diaphragm that would allow the transfer of fluid. When there is a large amount of ascites there is an enormous amount of pressure in the abdominal cavity.

Approximately one person out of five who have had a pneumothorax(collapsed lung) will have another one.

Ascites is caused by leaking membranes because his albumin(protein) is low and he has portal hypertension. Protein keeps membranes, tissues, blood vessels etc from leaking their fluid. Combine this leaking with portal hypertension(increased pressure in the blood vessels trying to force blood through a scarred liver causes a back up of blood. All of this leaking and pressure can cause fluid in the lungs (pleural effusion).

Is your husband planning to have a liver transplant if his liver fails?

Has anyone discussed a MELD Score with you? A MELD Score will determine how well your husbands liver is functioning, when it is time for a liver transplant evaluation and when it is time for a liver transplant. You can go on line and get your husbands MELD Score by entering his INR,Creatinine and Bilirubin. It will range from around 6-40, with 6 being minimal liver disease and 40 being seriously ill with end stage liver disease. A transplant evaluation usually happens with a MELD Score between 14-20 depending on the transplant center with a transplant being done with a MELD in the 20's, maybe as high as 30, depending on what region he is listed in.

It appears that you are keeping up with his labs. Please keep doing so, also get copies of any xrays, scans, ultrasounds etc. Keep all of this in a folder or notebook along with a current medicine list. Believe me this will come in handy. Take this folder or notebook to all md visits and er visits. If you go out of town take it with you.

As far as his cough, if you feel something is wrong then act on it and don't let anyone ignore it. If you have been reading here for awhile , you will have read of stories about how cirrhosis patients are treated in the medical community. Don't let them be disrespectful to you or your husband. It doesn't matter what caused the cirrhosis, he is a human being, he is sick and deserves to be treated with respect and dignity.

I am a nurse and also a cirrhosis survivor and a liver transplant recipient. From what I went through with cirrhosis and having dealt with patients during my nursing career I would at least attempt to get an answer regarding this cough.You may never have a reason for the cough. It may be nothing and I sincerely hope it is nothing. But, you don't know until it is investigated further. With cirrhosis always expect the unexpected.

I hope your husband continues to have a good appetite and gets rid of that cough.

Take care of yourself.

Vivian