Topic: Ascites and antibiotics

My husband received a call from the oncologist's nurse today about his CT scan results.  The good news is that the tumors in his liver have not changed.  However, the scan indicated that he has fluid in his abdomen. (His past scans showed mild ascites but the amount of fluid has increased.)   The nurse said that the doctor wants him to start antibiotics immediately as he hopes they may take care of the problem.  Does anyone understand how antibiotics could reduce ascites?  I can't understand the connection.

Re: Ascites and antibiotics

I don't understand either unless the Dr believes its from an infection (like peritonitis) causing more fluid.

Willow

Re: Ascites and antibiotics

Hi Linda,
I did a google search of ascites and antibiotic treatment.  I found out that if a patients WBC count is high, a bacterial infection may be responsible and antibiotics are indicated.  I didn't know about this either, and you got me curious. Wishing for the best for you guys.
Dianne

Re: Ascites and antibiotics

Here's a little more background.  He has been having fevers and was sent to the ER last week.  They did blood and urine tests, chest XRay, etc. but everything was negative.  His blood counts were actually pretty good. However, his liver enzymes were elevated.  I'm having trouble understanding how all this is related.  Do ascites mean that the cancer has progressed or can they also be related to a decrease in liver function, possibly caused by chemo?

Re: Ascites and antibiotics

Hi,
After reading  an article,  there are no indication for using antibiotics unless  patient has fever at diagnosis.
Therefore I believe to prescribe  antibiotics BEFORE the evaluation of the  content of the  ascites fluid and the possible elevated neutrophil count  in the fluid is more for PROPHYLAXIS purpose   than  the standard treatment protocol.

God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

6 (edited by PCL1029 Mon, 17 Jun 2013 19:35:44)

Re: Ascites and antibiotics

Hi,

Ascites in patient with liver diseases is more related to the portal vein hypertension because the tumors obstruct or compress  the portal veins. Starting doses of diuretics are Lasix up to 40mg/day and Aldactone up to 100mg/day. These doses should be adjusted upward (while maintaining this ratio) to achieve natriuresis and weight loss.--uptodate.com.


God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Ascites and antibiotics

Thanks so much!  My problem is that my husband was the one who talked to the nurse and he didn't ask all the questions I would have asked.  He says I have to calm down and wait until we see the doctor next week.  I hate to admit it but I think he's probably right.

8 (edited by marions Mon, 17 Jun 2013 23:28:46)

Re: Ascites and antibiotics

Linda....  As mentioned, spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of the ascitic fluid.  Hopefully this is confirmed with your husbands positive response to the antibiotics. 
This is what I have learned: Your husband's fever may not be related to the ascities however, ascities and the fever may be related to advanced disease. But, only the physician can answer your question correctly. 
I found this article.  It may answer your question re: the build-up of abdominal fluids (ascities.)
http://www.macmillan.org.uk/Cancerinfor … 6_Anchor_1
Fingers are crossed for a fantastic response to the antibiotics.  Oh, I also wanted to ask: is your husband taking diuretics for the ascities?  Also, does he have fluid-build up in his lower extremities?
Hugs to you,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Ascites and antibiotics

Thanks Marion.  He isn't taking diuretics at the present time.  "Mild ascites" have been identified in several of his previous scans but the doctor didn't seem very concerned about it.  I'm not sure exactly how much fluid showed up on the scan this time but it hasn't caused him any discomfort so far and he does not have any swelling in his extremeties.  He was feeling very well until about ten days ago.  Then he developed fever, mild indigestion, loss of appetite, taste distortion and fatigue.  His liver function has always been pretty good but the blood test he had last Sunday (two days after chemo) showed very high ALT, AST and ALP.  Albumin was low and bilirubin (which has always been normal) was 2.4.  Tumor markers were normal, as always. I was worried that the tumors in his liver might be growing but the scan showed they were stable.  I'll let you know how he does.

Re: Ascites and antibiotics

Hi,

My husband gets tapped for roughly 5L every five days. Every dr we have spoken to has said a catheter or anything else is too risky for infection. We have gone to ER once, after a drain, infection. Nothing serious. One point to mention, we've recently started acupuncture and he is MUCH more comfortable.  Food luck!!!

11 (edited by marions Tue, 18 Jun 2013 20:47:04)

Re: Ascites and antibiotics

Linda....there is visible disease progression and then there is that what cannot detected by scans as the plates are 1cm.  Hence, anything smaller than that can only be observed by the eye of the surgeon.  The blood test results are indicative of something going on and his physicical symptoms confirm this.  Don't hesitate from speaking with his physician.  Thinking of you and sending tons of hugs your way.
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Ascites and antibiotics

Thanks Marion.  I know there can be progression even if it doesn't show up on the scan but I am still hoping that some of these problems are related to infection instead of progression.   When he had blood tests on Friday the 14th, his bilirubin was in the normal range and AST and ALT were not too high (64 and 75).  Two days later, when we went to the ER because of his fever and low blood pressure, the bilirubin was 2.4, the AST was 201 and the ALT was 173.  His neutrophils also increased substantially over the 2-day period. The doctor started him on Levofloxacin a couple of days ago so we will see whether it has any effect.  He has an appointment on Friday and will have more blood tests then.  Unfortunately, his oncologist is on vacation so we will be seeing someone else.  He had a fever yesterday afternoon but his blood pressure is normal now.  If the disease has progressed, however, then we will try something else.  We're a long way from giving up.

Re: Ascites and antibiotics

Linda...my husband had several similar reactions to treatment and response to the antibiotics was slow, but steady. The neutropenia responded well to filgrastim injections. Tons of good wishes for Friday's visit.
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Ascites and antibiotics

A little good news today.  After three days on antibiotics, my husband had no fever for the first time in two weeks.  His energy level was a little better too. Hoping to get some more information at his doctor's appointment tomorrow.

Re: Ascites and antibiotics

A little bit more than a little good news, dear Linda.  Thanks for sharing the great news with us.
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Ascites and antibiotics

YEA, Linda! That is good news. It's just so worry some as with CC it could be quite a few different things. Sounds like he is on the right track. I will keep everything crossed for you both. Good luck tomorrow!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Ascites and antibiotics

This is indeed good news Linda, thanks for letting us know. Hope that the meeting with the doc goes well and that you get some good news from it.

Hugs,

Gavin

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: Ascites and antibiotics

I wanted to provide an update on my husband's condition in the event anyone researching ascites reads this thread in the future.  Although it was my understanding that the doctor put my husband on antibiotics because his scan revealed ascites, I later learned that the scan also revealed signs of infection, possibly pancreatitis, and this was the reason for the antibiotics.  Apparently the infection caused his albumin level to drop far below normal and this caused a host of problems.  After 17 days of antibiotics, he is greatly improved.  He has no fever and his blood pressure has returned to normal.  His bilirubin had risen to 3.4, causing some jaundice, but it has dropped to 1.5 and the jaundice is all gone.  Almost all of his digestive problems are gone and his appetite has returned to normal. I won't know whether there has been any change in the ascites in his abdomen until the next scan but the fluid around his ankles is now gone.  The albumin level has been rising slowly and is now only slightly below normal.  All of the tests he had in the ER were negative for infection so it is fortunate it showed up on the scan.  I plan to take any future fevers very seriously.

Re: Ascites and antibiotics

Linda that is all so wonderful, I love to go to bed with good news. Woot! Woot!
Teddy used to get blood infections like 2 X a year and they were horrible. He would get the chills so bad I would put 3 covers on him and lay on top, then his temp would go up to 102-103, then he got so weak he could not stand up. All this occurred in about 30 minutes. So I learned quickly to call the Ambulance as I could not even walk him to the car. The ONC said anything in a temp over 101 go right to ER. Then they learned that he did great on Levaquin in an IV but each time was at least a 3-4 day Hospital stay. Oh the things we learn from CC, from what is that, Never heard of it to what? A liver transplant? I wish CC stood for 'common cold'. But I am so very happy for your good news!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Ascites and antibiotics

Linda....fantastic news. 
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Ascites and antibiotics

Great news Linda! Thanks for that!

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.