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Ascites - Symptoms, Causes, Diagnosis, And Treatment

Ascites is the build-up of an abnormal amount of fluid in the abdomen. The build-up causes swelling that usually develops over a period of a few weeks. But it is not the same in all cases, as the swelling can develop in just a few days as well. It condition causes severe discomfort to the individuals affected. Caused by severe liver disease, ascites swells up your belly and will cause it to protrude. Ascites is classified into two types, transudative or exudative, based on the amount of protein found in the fluid [1] , [2] .

The condition is commonly found in individuals with cirrhosis (scarring) of the liver. It has been reported that about 80 per cent of patients with cirrhosis of the liver develop ascites. Normally, only a small amount of fluid is present in the sac (20 ml), but in individuals with ascites, the fluid amount will be more than 20 in the peritoneal cavity. Apart from liver diseases, cancer that spreads to the peritoneum can also cause this condition as it leaks the fluid. In some illness, the excess accumulation of water and sodium can also lead to ascites [3] .

Ascites

As aforementioned, it is most commonly found in individuals suffering from liver diseases as the liver will not possess the ability to produce enough protein to retain fluid in the bloodstream, thereby causing the lack of total protein in the body and leakage of water into the surrounding tissues. Liver diseases can also cause an obstruction of blood flow through the scarred cirrhotic liver [4] . Depending on the severity of the condition, the survival rate is between 20 to 58 weeks. Not all individuals with the condition die, but the ones with severe symptoms can as ascites shut down the functioning of your liver [5] .

Symptoms Of Ascites

The condition can cause the person discomfort and pain. If the condition is mild, it will not show any signs. The signs and symptoms are as follows [6] , [7] :

  • Tiredness
  • A distended (swollen) abdomen
  • Nausea and vomiting
  • Breathlessness and difficulty breathing when lying down
  • Lack of appetite
  • Urinary urgency
  • Constipation
  • Sudden weight gain
  • Abdominal pain
  • Bloating
  • Heartburn
  • Hernia
  • Swelling in legs and ankles
  • Indigestion

When To See A Doctor

Naturally, if you develop an unexplained abdominal swelling you must immediately go to a doctor and seek medical attention. If you are having a constant fever and abdominal pain, visit a doctor to examine the underlying reason behind the signs. Also, if it is causing difficulty in normal daily tasks such as walking or running, it is imperative that you immediately go to the doctor [8] .

Causes Of Ascites

The primary reason behind the condition is liver scarring or cirrhosis, which increases the pressure inside the liver blood vessels. The pressure forces the fluid into the abdominal cavity, causing ascites [9] .

  • Budd-Chiari syndrome
  • Tuberculosis
  • Kidney disease
  • Pancreatitis
  • Underactive thyroid
  • Cancer

If cancer affects the following parts in your body, ascites can develop [10] .

  • Ovaries
  • Lung
  • Liver
  • Breast
  • Peritoneum
  • BowelUrl:

ascites-symptoms-causes-diagnosis-and-treatment

  • Lymphatic system
  • Pancreas
  • Stomach
  • Womb

Some of the least common causes of the condition are mentioned below [11] .

  • Nephrotic syndrome
  • Disorders of the pancreas
  • Direct irritation of the peritoneum
  • Diseases of the ovary

Risk Factors Of Ascites

The below-mentioned conditions can increase your risk of developing ascites. The conditions include [12]

  • ovarian, pancreatic, liver, or endometrial cancer,
  • heart or kidney failure,
  • pancreatitis,
  • tuberculosis, and
  • hypothyroidism.

Diagnosis Of Ascites

In order to examine and understand the signs and symptoms of the condition, the doctor will go through your medical history as it can help in providing clues to the underlying cause. The doctor may ask you questions about the following aspects [13] :

  • Previous diagnosis of liver disease
  • Viral hepatitis infection and its risk factors
  • Alcohol abuse
  • A family history of liver disease
  • Heart failure
  • Cancer history
  • Medication history

After that, the doctor will conduct a physical examination where he/she will check for any swelling in the abdomen [14] .

  • Blood tests will be carried out to assess liver and kidney function. If in case cirrhosis is confirmed, further tests will be conducted to clarify the cause, which will include antibody tests for hepatitis B or C as well.
  • Abdominal ultrasound, which will help in identifying the underlying causes of ascites. It will help in understanding whether the person has cancer or if cancer has spread to the liver.
  • Fluid sample analysis will be carried out by taking a sample of abdominal fluid, which will help in understanding the presence of cancer cells and infection. The fluid sample will be acquired from your body with a syringe and will be sent to a laboratory for analysis.

The doctor will check for the fluid using the following methods as well [15] :

  • Imaging tests
  • Fluid sample analysis
  • Ct scan
  • Mri
  • Laparoscopy
  • Angiography

Treatment For Ascites

Once the doctor conducts the diagnosis, clarity on the situation will be gathered and the suitable treatment methods will be applied depending on the severity of your condition.

1. Diuretics or water pills

This method is the most commonly used one for treating ascites. You will be directed to increase the amount of salt and water leaving your body, so as to reduce the pressure within the veins around the liver. While undergoing diuretics, your doctor will also monitor your blood chemistry. The treatment method requires you to reduce your alcohol use and salt intake [16] .

2. Paracentesis

This method is used for resistant cases, and in cases where there is a significant amount of excess fluid. Paracentesis uses a thin, long needle to remove the excess fluid. The needle is inserted through the skin and into the abdominal cavity after the patient is given local anaesthesia. In this treatment, the risk of infection is present [17] . So, people who undergo paracentesis will be prescribed antibiotics. This treatment will not apply during the late-stage of ascites.

3. Surgery

In the case of ascites caused by cancer, the doctors will use a shunt which is a tube to move the fluid from the abdomen and into the bloodstream. The procedure involves the insertion of a needle into a vein in the neck, and a shunt will be placed along the chest wall [18] . The shunt acts as a connection between the abdominal cavity and the neck, as this helps the fluid to move along the tube into the bloodstream. In some cases, a liver transplant is suggested (patients who have cirrhosis and ascites).

4. Chemotherapy

This will help in shrinking the cancer. Chemotherapy can be administered through a tube in the abdomen, which sometimes can stop the fluid build-up [19] .

Management Of Ascites

The condition cannot be prevented. However, you can manage the signs and symptoms, and lower the risks of developing it by paying care and attention to your liver. Adopt the following healthy habits to help your liver [20] .

  • Practice safe sex, because hepatitis can spread sexually as well.
  • Get vaccinated for hepatitis B.
  • Drink alcohol in moderation, as it can help prevent cirrhosis that is, scarring of the liver.
  • Avoid intravenous drug use, because hepatitis can be transmitted through shared needles.
  • Be aware of the potential side effects of your medications because, if liver damage is a risk, talk to the doctor about checking your liver function.
View Article References
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  2. [2] Arroyo, V., Ginès, P., Gerbes, A. L., Dudley, F. J., Gentilini, P., Laffi, G., ... & Schölmerich, J. (1996). Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis.Hepatology,23(1), 164-176.
  3. [3] Moore, K. P., Wong, F., Gines, P., Bernardi, M., Ochs, A., Salerno, F., ... & Jimenez, W. (2003). The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club.Hepatology,38(1), 258-266.
  4. [4] Runyon, B. A. (2009). Management of adult patients with ascites due to cirrhosis: an update.Hepatology,49(6), 2087-2107.
  5. [5] Ginès, A., Escorsell, A., Ginès, P., Saló, J., Jiménez, W., Inglada, L., ... & Rodés, J. (1993). Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites.Gastroenterology,105(1), 229-236.
  6. [6] Parsons, S. L., Watson, S. A., & Steele, R. J. C. (1996). Malignant ascites.British journal of surgery,83(1), 6-14.
  7. [7] Ringenberg, Q. S., Doll, D. C., Loy, T. S., & Yarbro, J. W. (1989). Malignant ascites of unknown origin.Cancer,64(3), 753-755.
  8. [8] Williams, J. W., & Simel, D. L. (1992). Does This Patient Have Ascites?: How to Divine Fluid in the Abdomen.Jama,267(19), 2645-2648.
  9. [9] Runyon, B. A., Montano, A. A., Akriviadis, E. A., Antillon, M. R., Irving, M. A., & McHutchison, J. G. (1992). The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites.Annals of internal medicine,117(3), 215-220.
  10. [10] Runyon, B. A. (1994). Care of patients with ascites.New England Journal of Medicine,330(5), 337-342.
  11. [11] Laterre, P. F., Dugernier, T., & Reynaert, M. S. (2000). Chylous ascites: diagnosis, causes and treatment.Acta gastro-enterologica Belgica,63(3), 260-263.
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  13. [13] McHutchison, J. G. (1997). Differential diagnosis of ascites. InSeminars in liver disease(Vol. 17, No. 03, pp. 191-202). © 1997 by Thieme Medical Publishers, Inc..
  14. [14] Prieto, M., Gómez-Lechón, M. J., Hoyos, M., Castell, J. V., Carrasco, D., & Berenguer, J. (1988). Diagnosis of malignant ascites.Digestive diseases and sciences,33(7), 833-838.
  15. [15] Menzies, R. I., Fitzgerald, J. M., & Mulpeter, K. (1985). Laparoscopic diagnosis of ascites in Lesotho.Br Med J (Clin Res Ed),291(6493), 473-475.
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Story first published: Friday, March 15, 2019, 9:00 [IST]
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