bluebanded goby
Contributor
I have a friend who is interested in diving, but he mentioned that he has liver disease and wonders if that would be a problem. Any thoughts on this? Thanks in advance.
Liver disease and diving?
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I reviewed the PADI medical form, and physician's guidelines for evaluation of scuba divers.
There is no direct question pertaining to liver disease, but your friend may fall under some "catch-all" questions.
Regardless, your friend should be evaluated for fitness to dive by a physician. Concerns regarding the ability to tolerate moderate exercise involved with diving should be addressed.
There is no direct question pertaining to liver disease, but your friend may fall under some "catch-all" questions.
Regardless, your friend should be evaluated for fitness to dive by a physician. Concerns regarding the ability to tolerate moderate exercise involved with diving should be addressed.
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Hi bluebanded goby,
As you no doubt appreciate, the term "liver disease" is rather imprecise. There are number of diseases of the liver, including inherited conditions, acute & chronic viral hepatitis of various types, cirrhosis & cancer.
It would be necessary to have much more description of his situation before anything useful could be offered.
Best regards.
DocVikingo
As you no doubt appreciate, the term "liver disease" is rather imprecise. There are number of diseases of the liver, including inherited conditions, acute & chronic viral hepatitis of various types, cirrhosis & cancer.
It would be necessary to have much more description of his situation before anything useful could be offered.
Best regards.
DocVikingo
DocVikingo is correct in that it would be impossible to give you a proper answer without more information. Liver disease can be mild or severe. It can be cirrhosis from many causes or it can be cancer. It can be due to blockage of bile ducts from stones or malignancy in the pancreas.
Most often, however, it is from cirrhosis due to hepatitis or alcohol. As you might expect, there is nothing published about cirrhosis and diving. Fred Bove doesn't mention it in his book nor does Carl Edmonds.
In 'Medical Examination of Sport Scuba Divers'. Bove and Davis, p.49. it is stated that "Significant fatty liver is disqualifying because of the danger of inert gas excess and rupture of fat cells due to bubble formation.with resulting serious decompression illness complicated by fat embolism."
I cannot find a citation to back this up.
-------------------------------------------------
Biliary tract disease with stones and stents is not a contra-indication to diving.
--------------------------------------------------
There is a letter in the Am J Gastroenterol 2000 Dec;95(12):3677-8
"Massive variceal bleeding caused by scuba diving."
Nguyen MH, Ernsting KS, Proctor DD.
Esophageal varices are dilated veins in the lower end of the esophagus that are causesd by blockage of blood flow in the cirrhotic liver. Apparently the barotrauma of the gastric gas bubble is capable of causing these to rupture.
There are some other peripheral problems that should be cautionaries, however. Venous bubbles will reduce the platelet count. Add this to the cirrhotics' bleeding diathesis and there might be trouble from sinus, ear or lung barotrauma.
If there is any degree of ascites (fluid in the abdomen), then the person should not dive as this
possibly will lead to congestive failure from the fluid shifts that take place centrally with immersion. I have one anecdotal report of this happening with a person in renal failure diving wet from peritoneal dialysis.
Nitrogen accumulation in the fluid can conceivably occur and might possibly be a problem with off-gassing due to slow filtration - but this is only a supposition.
A Medline search fails to elucidate.
Best advice - the clinical picture dictates; if ascitic, the person should not dive.
If the liver disease is due to hepatitis C, there are many different stages of HCV and it would be impossible to tell you whether or not you can dive without having access to your records and being able to examine you.
Interferon is one of the treatments of this condition which can cause side effects that can mimic the symptoms of a decompression accident. These can include any or all of the following:
flu-like symptoms, fatigue, muscle pain and joint pain. Skin problems can include hair loss and dry skin - problems that can be increased by sun exposure. It also causes some immuno-suppression which subjects you to the possibility of marine infections that are not ordinarily a problem, such as vibrio species.
The liver is primarily affected and can enlarge significantly in the early stages of the condition. An enlarged liver exposes you to the risk of traumatic rupture.
Diving generally should depend on the extent of the liver involvement and should be monitored closely by your private physician as to whether or not you should participate in diving activities.
Visit our web page about Hep C and diving at
http://www.scuba-doc.com/hepc.html
So many things can happen with "liver disease" that again, our best advice would be not to dive unless cleared by a physician knowledgeable in diving medicine.
Best regards:
scubadoc
Diving Medicine Online
http://www.scuba-doc.com/
Subscribe to Ten Foot Stop Newsletter
http://snipurl.com/buk8
Most often, however, it is from cirrhosis due to hepatitis or alcohol. As you might expect, there is nothing published about cirrhosis and diving. Fred Bove doesn't mention it in his book nor does Carl Edmonds.
In 'Medical Examination of Sport Scuba Divers'. Bove and Davis, p.49. it is stated that "Significant fatty liver is disqualifying because of the danger of inert gas excess and rupture of fat cells due to bubble formation.with resulting serious decompression illness complicated by fat embolism."
I cannot find a citation to back this up.
-------------------------------------------------
Biliary tract disease with stones and stents is not a contra-indication to diving.
--------------------------------------------------
There is a letter in the Am J Gastroenterol 2000 Dec;95(12):3677-8
"Massive variceal bleeding caused by scuba diving."
Nguyen MH, Ernsting KS, Proctor DD.
Esophageal varices are dilated veins in the lower end of the esophagus that are causesd by blockage of blood flow in the cirrhotic liver. Apparently the barotrauma of the gastric gas bubble is capable of causing these to rupture.
There are some other peripheral problems that should be cautionaries, however. Venous bubbles will reduce the platelet count. Add this to the cirrhotics' bleeding diathesis and there might be trouble from sinus, ear or lung barotrauma.
If there is any degree of ascites (fluid in the abdomen), then the person should not dive as this
possibly will lead to congestive failure from the fluid shifts that take place centrally with immersion. I have one anecdotal report of this happening with a person in renal failure diving wet from peritoneal dialysis.
Nitrogen accumulation in the fluid can conceivably occur and might possibly be a problem with off-gassing due to slow filtration - but this is only a supposition.
A Medline search fails to elucidate.
Best advice - the clinical picture dictates; if ascitic, the person should not dive.
If the liver disease is due to hepatitis C, there are many different stages of HCV and it would be impossible to tell you whether or not you can dive without having access to your records and being able to examine you.
Interferon is one of the treatments of this condition which can cause side effects that can mimic the symptoms of a decompression accident. These can include any or all of the following:
flu-like symptoms, fatigue, muscle pain and joint pain. Skin problems can include hair loss and dry skin - problems that can be increased by sun exposure. It also causes some immuno-suppression which subjects you to the possibility of marine infections that are not ordinarily a problem, such as vibrio species.
The liver is primarily affected and can enlarge significantly in the early stages of the condition. An enlarged liver exposes you to the risk of traumatic rupture.
Diving generally should depend on the extent of the liver involvement and should be monitored closely by your private physician as to whether or not you should participate in diving activities.
Visit our web page about Hep C and diving at
http://www.scuba-doc.com/hepc.html
So many things can happen with "liver disease" that again, our best advice would be not to dive unless cleared by a physician knowledgeable in diving medicine.
Best regards:
scubadoc
Diving Medicine Online
http://www.scuba-doc.com/
Subscribe to Ten Foot Stop Newsletter
http://snipurl.com/buk8
OP
bluebanded goby
Contributor
Thanks much for the replies from Scubadoc and DocVikingo. I don't know the details of my friend's situation beyond what he mentioned to me (about having "liver disease"). I'll pass on this info and suggest he run it down with his doctor before considering an OW class.
I was interested in the one reference which said that "Significant fatty liver is disqualifying because of the danger of inert gas excess and rupture of fat cells due to bubble formation." Is this based on the same idea that counsels not to dive if you are significantly obese? We all have some degree of fat tissue, but I guess it's only a significant risk when there's a lot of it in the body -- or a lot concentrated in one place, like a liver?
I was interested in the one reference which said that "Significant fatty liver is disqualifying because of the danger of inert gas excess and rupture of fat cells due to bubble formation." Is this based on the same idea that counsels not to dive if you are significantly obese? We all have some degree of fat tissue, but I guess it's only a significant risk when there's a lot of it in the body -- or a lot concentrated in one place, like a liver?
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