Cirrhosis and Ascites
query from a scuba instructor:
57 year old male,
history of alcoholism & suffering cirrohsis of the liver. Very
large, distended belly ( has the largest "outie" belly button you've
ever seen! ), but otherwise not obese. Passed the N.A.U.I. pool
test better than most of his classmates. Claims his drinking days
are past & has non-diving physician, unrestricted approval to
participate. No other medical contraindications noted on the standard
N.A.U.I. medical questionaire. He is an educated man ( prof. engineer )
with previous sport diving experience years ago... What is your advice?
It is highly likely that your diver has
ascites (large quantities of free fluid in his abdomen surrounding his
organs). In addition to his umbilical hernia (which can rupture easily
under these circumstances) which has occurred in response to the excess
pressure of the fluid - it is also highly likely that he has esophageal
varices or dilated blood vessels in the lower end of his gullet.
Due to the effects of
immersion on the blood supply of the body, during a dive blood is
shunted from the periphery into the blood vessels of the
gastrointestinal tract, liver and spleen. This would cause dilation and
possible rupture of the esophageal varices with massive hemorrhage. Add
to this the acid reflux changes that occur about the cardia (lower end
of the gullet and upper stomach) due to the action of Boyle's law
during ascent and we have a set up for rupture of not only the varices
but the stomach.
This not just a
theoretical possibility but has been reported.
bleeding caused by scuba diving.
Am J Gastroenterol. 2000 Dec;95(12):3677-8.
Nguyen MH, Ernsting KS, Proctor DD.
Finally, cirrhosis of the liver
to the extent that it causes ascites can have significant mental
effects of obtundation of the intellect. Hepatic encephalopathy can
cause apathy, confusion, disorientation, drowsiness and slurred speech.
This alone would be dangerous enough
to disallow diving.
Because of what I consider significant risk,
I would not certify this person as fit to dive.