About ascites

What is ascites?

Ascites is the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) in the abdominal (peritoneal) cavity. The abdominal cavity is located below the chest cavity, separated from it by the diaphragm. Ascitic fluid can have many sources such as liver disease, cancers, congestive heart failure, or kidney failure.

What are the symptoms for ascites?

Ascites is usually accompanied by a feeling of fullness, a ballooning belly, and fast weight gain. Other symptoms often include:

If you have a combination of these symptoms, see your doctor. If you have ascites, it’s often a sign of liver failure. It occurs most often with cirrhosis.

What are the causes for ascites?

Ascites happens when pressure builds up in the veins of your liver and it doesn’t work as it should. These two problems usually are caused by another condition -- cirrhosis, heart or kidney failure, cancer, or an infection.

The pressure blocks blood flow in the liver. Over time this keeps your kidneys from removing excess salt from your body. This, in turn, causes fluid to build up.

What are the treatments for ascites?

People with ascites should be routinely followed by their primary physician and any specialists that may be involved in their care. Gastroenterologists (specialists in gastrointestinal diseases) and hepatologist (liver specialists) commonly see patients with ascites due to liver disease. Other specialists can also care for patients with ascites based on the possible cause and the underlying condition. The specialists usually ask the patient to first contact their primary physician if ascites increase. If ascites is causing symptoms of shortness of breath, abdominal discomfort ,or inability to do normal daily tasks such as walking, the patient's primary doctor should be notified.

What are the risk factors for ascites?

Any disease that causes liver damage or scarring can make you more likely to get ascites. Common risk factors for ascites include: 

  • Viral infections like hepatitis B or hepatitis C
  • Alcohol misuse
  • Cancer in organs in the belly area
  • Kidney failure
  • Congestive heart failure

Is there a cure/medications for ascites?

Ascites is the pathological accumulation of fluid in the peritoneal space, especially the abdomen. In a healthy human body, the peritoneal space contains a minute quantity of fluid. Ascites occur due to several disorders, including cirrhosis, chronic alcohol use, IV drug use, obesity, hypercholesterolemia, type 2 diabetes, nephrotic syndrome, severe malnutrition, pancreatic ascites, and ovarian lesions.

Treatment depends on the cause of ascitic fluid accumulation. The goals are to minimize the fluid volume and decrease peripheral edema without causing intravascular volume depletion.
Some of the treatments are as follows:

  • Abstinence from alcohol.
  • Restriction of dietary salt; creates negative sodium balance, lowers diuretic requirement, and resolves ascites faster.
  • Diuretics; spironolactone and furosemide in ratio 100:40 mg/day of dosage are the preferred diuretic agents. Diuretics enhance urine formation and remove water content.
  • Antibiotics - While patients with chlamydia peritonitis are treated with antibiotics such as doxycycline, ascites caused by lupus serositis may respond to glucocorticoids.
  • Paracentesis - It is a procedure in which a surgeon inserts a needle into the abdomen and removes the accumulated fluid. The procedure is for the cases only when the fluid volume is high.
  • Trans-jugular Intrahepatic Portosystemic Shunt (TIPS) - A stent is inserted into the hepatoportal vein to direct fluid to bypass the liver.

Cirrhosis,Chronic alcohol use,IV drug use,Obesity,Hypercholesterolemia,Type 2 diabetes,Nephrotic syndrome,Severe malnutrition,Pancreatic ascites,Ovarian lesions
Diuretics: spironolactone and furosemide, doxyciline, glucocorticoids
Progressive abdominal distension associated with abdominal discomfort,Weight gain,Early satiety,Shortness of breath, and dyspnea and increased abdominal pressure,Fever,Abdominal tenderness

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