Brief Answer:
Probable cirrhosis. Will need water pills.

Detailed Answer:
Hello XXXX, How are you? Thank you very much for writing into HCM. My name is Dr Suresh and I hope to answer your question today.
I am so sorry to hear about your Uncle's condition. By the things you have said, I understand that your uncle might have developed liver damage due to long standing alcohol use. There is no specific infection of the liver related to alcohol use. Long standing alcohol use damages the liver and subsequently leads to hardening of the liver - a term known as "cirrhosis". Early stages of cirrhosis are usually asymptomatic, but at later stages it leads to difficulty in blood from passing through the liver. This is called as "Portal Hypertension". The two main manifestations of portal hypertension is bleeding form the food pipe (oesophageal varices) and accumulation of fluid in the belly (Ascites). By the sound of it, your uncle seems to be suffering from ascites due to portal hypertension. When enough fluid accumulates, it leads to difficulty in breathing due to pressure in the belly and so difficulty in talking too. Also since he is concomitantly being treated for tuberculosis, the drugs used to treat TB usually has toxic effects on the liver.
The portal hypertension is usually treated with medications to decrease the pressure and also water pills (diuretics) to decrease the fluid accumulation in the belly. But this will take a while to work and so if the patient is having difficulty in breathing, then the fluid is drained by inserting a small needle into the belly. The fluid drained can then also be sent to the laboratory for analysis to rule out any infection (especially tuberculosis of the belly in your uncle's case).

Your uncle will need a lot of investigations including a hemogram, liver function tests and kidney function tests. He will also need a ultrasound scan of the liver to look for cirrhosis of the liver.
Please consult a surgeon or a physician at the earliest so they can remove the fluid in the belly and also scan the liver.

Hope this helped and hope your uncle feels better soon. Please do not hesitate to contact me for further clarifications and please do get back to me with the reports.

Dr Suresh

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