Alcoholism destroys the liver by replacing normal liver tissue with fibrotic tissue, which can’t perform normal liver functions. When enough of the liver turns fibrotic, the liver can no longer carry out its extensive duties, which include producing enzymes and proteins and removing toxins and waste. The alcoholic often develops a large stomach when the liver loses much of its ability to function.
A large stomach in an alcoholic indicates that protein rich fluid is leaking from the blood vessels around the liver and accumulating in the stomach. This fluid, known as ascites, distends the stomach and often seeps down into the legs and feet as well.
Ascites occurs when production of albumin, a protein synthesized in the liver, drops because of decreased liver functioning. Albumin normally helps keep fluid in blood vessels. At the same time, the scarring caused by liver failure results in increased pressure in the portal vein, the blood vessel that leads into the liver. That causes a fluid backup, forcing excess fluid from the blood vessels into the abdomen to accumulate as ascites, according to the Gale Encyclopedia of Medicine.
Ascites puts pressure on nearby organs like the lungs, making it hard to breathe. The crowding of the stomach and intestines makes it hard to eat and decreases appetite. Infection, known as spontaneous bacterial peritonitis, or SBP, can also occur in the fluid. Death can occur if the infection isn’t promptly recognized and treated, according to the Merck Manual. Severe fatigue and discomfort often accompany ascites.
Ascites treatment aims at decreasing the amount of fluid and at removing excess fluid when it interferes with breathing and activities of daily living. Diuretics like Lasix and Aldactone are usually given to pull excess fluid from the tissues, and doctors recommend salt limitations of 1500 milligrams per day, the University of Maryland Medical Center states. Paracentesis is also done as needed to withdraw fluid from the abdomen with a large needle. Intravenous albumin may help keep fluid in the tissues.
In some cases, a procedure known as TIPS (for transjugular intrahepatic portosystemic shunt) lets blood bypass the liver to decrease ascites fluid buildup. The procedure, however, can cause an increase in encephalopathy, confusion and mental changes related to toxin buildup in the brain.
Ascites indicates severe liver failure in an alcoholic. Once ascites develops, 85 percent of alcoholics survive one year without a liver transplant and 56 percent survive 5 years. If patients don’t respond to salt restriction and diuretics, the survival rate drops to 50 percent at two years, writes Bahaa Eldeen Senousy of Cairo's Ain Shams University School of Medicine in the Jan. 7, 2009, edition of the “World Journal of Gastroenterology.” Alcoholics who develop ascites must stop drinking and seek medical attention and addiction treatment to have any chance at a normal lifespan.