Cirrhosis: ascites, weight and girth, encephalopathy, variceal bleeding and the skin

What it is

In cirrhosis the scarred liver causes fluid in the abdomen (ascites), bleeding from varices, confusion from toxins the liver cannot clear (hepatic encephalopathy), infection of the ascitic fluid and skin changes such as jaundice and easy bruising. The nurse tracks fluid with daily weights and the fluid balance, watches for the earliest signs of encephalopathy and its triggers, checks for bleeding and infection, and teaches the patient and family. The disease itself is on the condition pages.

What it requires

• A baseline weight and daily weights, and the abdominal girth if the protocol includes it.
• A fluid balance chart and a record of every bowel movement.
• A mental-state check every shift.
• Following the sodium, potassium and creatinine results while on diuretics.
• Teaching the patient and family the warning signs.

How it is applied (and why)

1. Weigh daily on the same scale, at the same time, in similar clothing — the trend shows fluid gain or loss.
2. Measure abdominal girth only as the protocol says, always at the same marked level — compare like with like.
3. Record intake and output and serve no-added-salt meals; restrict fluids only if ordered — salt, not water, drives the weight.
4. Check the mental state each shift: sleep, orientation, attention, handwriting, flapping tremor — early encephalopathy is subtle.
5. Record every stool and give the laxative treatment as prescribed — constipation triggers encephalopathy; diarrhoea dehydrates.
6. Question any sedative or opioid order and report drowsiness — these medicines can trigger encephalopathy.
7. Look for bleeding: vomit, stools, urine, gums and bruises — varices and poor clotting both bleed.
8. Look for infection: fever, abdominal pain, diarrhoea, new confusion — infected ascites must be found early.
9. Inspect the skin each shift for jaundice, bruising and oedema, and protect swollen skin as the protocol says.
10. Teach: no alcohol, low-salt food, every medicine and herb reviewed, vaccines, and when to seek emergency care.

In nursing practice

• Diuretic side effects to watch: low sodium, kidney impairment, encephalopathy, low or high potassium, muscle cramps and breast enlargement.
• Every patient admitted with cirrhosis and ascites has a diagnostic tap to look for infection; so do those with GI bleeding, fever, encephalopathy or worsening kidneys.
• Large-volume ascites is drained by paracentesis (see the linked page).
• Varices can bleed massively: follow the GI bleeding page and call at once.
• When ascites no longer responds and transplant is not an option, the guideline advises a palliative care referral.

Common mistakes

• Weighing on a different scale, at a different time or in different clothes.
• Restricting fluids without an order.
• Putting new confusion down to tiredness, or answering it with a sedative.
• Not recording stools while the patient is on laxative treatment.

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Elsewhere in DurgiPedia

• Ascites: shifting dullness and fluid wave
• Portal hypertension and the signs of chronic liver disease
• Cirrhosis: morphology

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Cirrhosis (MedlinePlus, U.S. National Library of Medicine, 2026); Hepatic encephalopathy (MedlinePlus, U.S. National Library of Medicine, 2026); Guidelines on the management of ascites in cirrhosis (Gut, British Society of Gastroenterology and British Association for the Study of the Liver (open access, PMC), 2021).

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