Ascites
This is pronounced Ay - sigh - tees and is an abnormal collection of fluid in the abdomen. This can be present for upto 6 weeks after the operation but should then disappear. If it recurs at any time this is usually a sign that the disease has affected the ability of the liver to make a protein called albumin.

One of the blood tests performed frequently after the operation and each time blood is taken in outpatients is to measure the albumin level. When the albumin level is too low, water from child's blood "leaks" out of the blood vessels and collects in the abdomen (in severe cases it may also collect in other parts of body).

The first sign of this problem is often when clothes do not fit so well over the tummy. This usually occurs gradually but may be started or worse by infection.

The doctor may measure your child's abdominal girth at each hospital visit and/or may ask you to do this at home. If your child's tummy becomes noticeably bigger while at home you should see your GP to exclude other causes such as wind or constipation for which he/she can advise you. Treatment for ascites may also be started by your GP or your local pediatrician in consultation with the specialist unit and does not necessarily mean admission to hospital.

Treatment is initially by medicine and/or altering the diet to maintain calorie in take but reduce fluid and salt intake. In more serious cases, it may be necessary to admit your child to hospital and give albumin intravenously through a "drip". You should never attempt to alter your child's diet and in particular, their fluid intake without medical advice.

Portal hypertension
Portal hypertension means high blood pressure in the portal vein, the main vein carrying blood from the gut to the liver and is different from high blood pressure. This may occur due to scarring in the liver, which causes backpressure to the portal vein. This may cause veins like varicose veins to develop in the lining of the gut, stomach or gullet.

These veins become fragile and bleed. It is rare for this to occur, before the child is two years old. Bleeding can cause black stools,pallor or vomiting of blood. If bleeding does occur, then contact your local hospital immediately. Treatment is available.

NEVER GIVE YOUR CHILD ASPIRIN OR IBUPROFEN OR ANY MEDICINES THAT CONTAINS ASPIRIN AS THIS MAY START THE ONSET OF BLEEDING.

Itching (Pruritus)
Some children with reduced bile flow experience itching of the skin. This can develop at any time and can make a child quite irritable and miserable. If you think your child may be affected consult your GP or specialist unit additional medicines may be required.