Advice after your nerve block for surgery
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Introduction
We hope you find the following booklet of help. It has been developed by your Liver Team at Frimley Health Foundation Trust; to help you and your loved ones identify and manage symptoms in advanced chronic liver disease, offering useful advice and guidance.
To support this booklet, further information is also available by scanning the QR codes throughout this booklet with your mobile phone camera, or by visiting the online links included.
You may also see liver disease referred to as decompensated liver disease or decompensated liver cirrhosis.
Please note, our Liver Specialist Nurse Team is also here to support you, and available for advice, guidance, and reassurance.
Managing Tiredness and Fatigue in Advanced Liver Disease:
Fatigue is a frequent and unpredictable symptom, which some days may feel manageable, while others simple tasks can be challenging.
To help conserve energy consider these strategies:
- Schedule regular rest or nap breaks throughout the day
- Prioritize tasks that are most important to you and your family
- Set realistic goals—avoid trying to do too much at once
- Ask for assistance from family, friends, or neighbours when needed
- Let people know you might need to adapt plans, such as leaving events early
- If you experience extreme sleepiness, such as falling asleep during conversations, this could be a sign of hepatic encephalopathy—a condition that requires medical attention.
- If fatigue is making it difficult to care for yourself, speak to your doctor, as you may be eligible for support services or care assistance.
Coping with fatigue - British Liver Trust
Diet and Nutrition in Advanced Liver Disease:
Maintaining a balanced diet is essential for your health, but you may experience a reduced appetite or have difficulty eating full meals. However, it is important you avoid long periods without food, as your body will start to breakdown muscle for energy, and this will lead to malnutrition, weakness and weight loss.
Tips to help with nutrition:
- Eat smaller, more frequent meals with regular snacks.
- Include carbohydrates and protein in each meal or snack—eg, cereal with milk, cheese or beans on toast, or a boiled egg
- Aim for a carbohydrate-based snack before bedtime to help prevent overnight muscle breakdown
- Avoid salty snacks and don’t add extra salt during cooking or at the table
- If you're struggling to maintain food intake, your doctor may prescribe nutritional supplements
- Speak to your GP or hospital team about a referral to a dietitian if eating continues to be a challenge
Diet and cirrhosis - British Liver Trust
Alcohol with Advanced Liver Disease:
Even if your liver condition wasn’t caused by alcohol, complete avoidance is essential.
- Even a small amount of alcohol can accelerate liver disease
- Check over-the-counter medications for alcohol content, especially cough mixtures
- Avoid alcohol-containing mouthwashes, as alcohol can be absorbed through blood vessels in the mouth
- Stay clear of foods cooked with or containing alcohol, such as certain desserts, sauces, or marinades
Portal Hypertension & Varices:
Cirrhosis causes scars in the liver, which block the blood flow through a large vein called the portal vein, which carries blood from your intestines and spleen to the liver. Because the blood can’t flow easily, the pressure in the vein goes up. This is called portal hypertension and may lead to varices (swollen veins) forming in the oesophagus or stomach. So, you may be offered a Gastroscopy (Endoscopy/OGD) to check for these.
If varices are found, a small rubber band may be applied, to shrink the veins and reduce risk of bleeding. If bleeding is already happening, treatment will be given during the procedure, and a follow-up gastroscopy may be needed later to check that the treatment has worked.
You may also be prescribed Carvedilol, (or in a few cases propranolol) a beta blocker, to lower portal vein pressure.
However, it is imperative that you seek urgent medical help:-
- If you vomit fresh blood or the appearance resembles coffee grounds,
- If you pass blood from your back passage, either fresh, red blood or black, sticky, offensive, tar-like stool.
Portal hypertension - British Liver Trust
Ascites and Oedema:
As liver disease progresses you may also develop ascites, which is fluid buildup in your abdomen causing swelling and discomfort and/or fluid collecting in your feet and legs (oedema). This is treated with diuretics or water tablets, such as spironolactone and furosemide. They will make you pee more, so it is best to take these in the morning. We will let you know if you need a regular blood test, as diuretics can affect the kidneys.
It is also advisable to: -
- Limit your fluid intake to 1.5 litres a day
- Not add any salt to your food.
- Keep an eye on your weight for any increase.
- Elevate legs and feet when sitting
Occasionally, ascites cannot be controlled by tablets alone, in which case, fluid may need to be removed from your tummy, with an ascitic drain, by a process called paracentesis. We arrange this for you, and the procedure is usually carried out as a day case by a dedicated team of Doctors and Nurses, within the hospital.
Ascites (swelling of your belly with fluid) - British Liver Trust
BLT-Ascites-Guide_June2022.pdf
Hepatic Encephalopathy (HE):
HE is a serious complication of advanced liver disease caused by toxins building up in the body and may signal worsening liver function, so it’s important to talk to your doctor promptly. It affects brain function and can be frightening but is often treatable and reversible with the right care.
Early signs may include:
- Feeling drowsy or less alert, sleeping more during the day and being awake at night
- Difficulty concentrating or remembering things
- Shaky or unclear handwriting
- Increased emotional sensitivity
More advanced signs:
- Tremors that make daily tasks harder
- Confusion or changes in personality
- Unsteady walking or frequent falls
Managing and Preventing HE:
- Constipation is a common trigger and should aim to have two soft bowel motions. You will likely be prescribed lactulose to help and can adjust the dose as required. In some cases, enemas or hospital treatment may be needed.
- You might also be prescribed Rifaximin, an antibiotic that works in the gut to reduce the production of ammonia by gut bacteria, and it’s absorption into the blood stream.
Itching (Pruritus):
Itching can be distressing and may affect sleep. It’s often linked to bile salt buildup in the skin.
Top tips to ease itching, include:
- Avoid scratching and keep nails short
- Bathe in lukewarm/cool water
- Wear loose fitting cotton clothes
- Avoid getting overheated – use a fan to keep cool
- Try not to spend too much time in hot environments or in the sun.
- Use mild fragrant free soaps.
- Use gentle, fragrance - free moisturizers to combat dryness.
- Apply a cold, wet cloth to the itchy area until the urge to scratch eases up.
- Avoid substances or materials that irritate your skin
If itching becomes troublesome, speak to your GP or liver specialist. They may recommend creams or medications. Please do not use over-the-counter antihistamines without medical advice.
Sex and Intimacy:
You may notice changes in sexual desire or function. This can be due to the condition itself or side effects of medications. It’s completely normal to find this difficult, both physically and emotionally.
You and your partner shouldn’t hesitate to speak with your GP support is available. They may offer advice, adjust treatments, or refer you to a specialist. Counselling for you and your partner can also help navigate the impact of liver disease on your relationship and intimacy.
Driving:
Symptoms like sleepiness, confusion, and extreme fatigue can affect your ability to concentrate and react quickly. It’s important to consider whether certain tasks could pose a risk to yourself or others, including driving, operating machinery, or supervising others.
If you're diagnosed with chronic hepatic encephalopathy (HE), the DVLA advises that you are not legally permitted to drive. Always speak with your doctor and inform the DVLA to stay safe and comply with the law.
Vaccinations:
You may be more vulnerable to infections and could become seriously ill if you get sick, so keeping up to date with your vaccinations is essential
Recommended vaccines include:
- Flu: Get a flu jab every autumn from your GP
- COVID-19: Seasonal boosters may be needed; additional doses may be advised for those with weakened immunity—check with your GP
- Pneumococcal (pneumonia): Recommended at diagnosis and every 10 years after
- Hepatitis A & B: These infections can be more serious if you already have liver disease—complete the full course and any boosters
- Shingles: Advised for those turning 65, ages 70–79, or age 50+ with a weakened immune system— ask your GP or Liver Consultant for guidance
For further information and support, you can also contact the British Liver Trust, by calling their helpline on 0800 652 7330 or on line at www.
Additional Information
Living with a liver condition - British Liver Trust
Support for you - British Liver Trust
BLT-Health-Wellness-Guide__June2022.pdf
Helpful contacts:
Liver Specialist Nurse team (HSN Team): -
Frimley Park Hospital – 0300 613 4239
Wexham Park Hospital – 0300 615 5676
Liver team secretary: -
Frimley Park Hospital – 0300 613 4080
Wexham Park Hospital - 0300 615 4774
Contact us
If you have any queries relating to this information, please contact the Hepatology (liver) service.
About this information
Service:
Hepatology (liver)
Reference:
H/064
Approval date:
1 July 2025
Review date:
1 July 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.