Ascites Overview & definition:

When fluid accumulates in the abdominal (peritoneal) cavity then it is known as ascites. Ascites generally occurs due to cirrhosis of the liver. Cancers, congestive heart failure, or kidney failure are the other causes of ascites. The treatment depends on the cause of ascites. Various treatment options are available including medications, surgery, diuretics, and paracentesis. As soon as you experience the symptoms of ascites, you should visit the best doctor. Sometimes, it can lead to a major complication if left untreated. Ascites is graded as:

1.   Grade 1: It is a mild ascites. Mild ascites can only be detected with the help of an ultrasound examination.

2.   Grade 2: It is a moderate ascites. Moderate ascites causes moderate symmetrical distension of the abdomen.

3.   Grade 3: It is large ascites. Large ascites causes marked distension of the abdomen.

Ascites Symptoms:

Sometimes, the symptoms of ascites are not visible especially if it is a mild ascites. The symptoms can appear slowly or suddenly as per the cause of the ascites. Whenever you experience the symptoms of ascites you should reach out to your doctor.  Check out the various signs or symptoms of ascites:

1.   Due to the accumulation of fluid in the abdominal cavity, people generally have the feeling of pain, discomfort and bloating in the abdomen.

2.   Nausea and vomiting are the signs of ascites.

3.   Due to ascites, there is a sudden gain in weight.

4.   In large ascites, people face the problem of shortness of breath due to more pressure on the diaphragm and fluid migration across the diaphragm leading to pleural effusions.

5.   Ascites diminishes your appetite.

6.   In ascites, people generally face difficulty in breathing when lying down.

7.   Heartburn is also a symptom of ascites.

These symptoms can also occur due to some other problem than ascites.

Causes of Ascites:

Ascites occurs when fluid accumulates in the abdomen. This generally happens due to the major problem of the liver known as cirrhosis. Although, the exact cause of ascites is still not known. These can be some of the causes of ascites:

1.   Liver damage is the biggest risk factor for ascites. Liver damage can happen due to cirrhosis, hepatitis B or C or a history of alcohol use.

2.   Due to portal hypertension, the pressure in the portal blood vessels increases which can contribute to ascites.

3.   Ovarian, pancreatic, liver or endometrial cancer may increase the risk of ascites.

4.   The other conditions that may increase the risk of ascites are heart failure, kidney failure, pancreatitis, tuberculosis, or hypothyroidism.

5.   Salt and water retention can contribute to ascites.

Ascites diagnosis

1.   As soon as you experience the symptoms of ascites, you should book an appointment with the best doctor for the diagnosis.

2.   Your doctor will do the physical examination and he will ask you about your detailed medical history in order to find out the possible causes of ascites.

3.   If the accumulation of fluid is greater than 500 ml then your doctor can easily recognise it with the help of physical examination.

4.   In physical examination, your doctor can diagnose the problem with the help of bulging flanks and fluid waves. Bulging flanks are a symptom or sign of ascites. The sides of your abdomen bulge out if you have large ascites. Fluid wave test is also done to diagnose ascites.

5.   If the fluid accumulation is less then it can be detected with the help of ultrasound of the abdomen.

6.   The most important thing is to know the underlying problems leading to ascites. It means finding out the answer to the question: What is the reason for developing ascites?

7.   The medical history is very helpful to know the reason or underlying cause due to which you are suffering from ascites. Your doctor can ask the questions about the previous diagnosis of liver disease, viral hepatitis infection and its risk factors, and alcohol abuse.

8.   Your doctor may also ask you about your family health history. The questions may include a family history of liver disease, heart failure, cancer, and medication.

9.   A blood test can also help to know the underlying cause of ascites.

10.  Sometimes, your doctor is not able to find out the underlying cause of ascites even after the examination of the family history and various blood tests. Due to this, it becomes necessary to do the analysis of the fluid. That is why doctors ask to get the paracentesis done.

11.  Trained physicians do the paracentesis. In this, a needle is inserted into the abdominal cavity for withdrawing fluid for the further analysis. A small amount of fluid around 20 cc which is less than a tablespoon is taken for the testing.

12.  Few litres of fluid which is a larger amount withdrawn if required in order to minimise the symptoms of ascites.

13.  After the drainage, the collected fluid is sent to the laboratory for the further diagnosis.

14.  In the laboratory, the analysis is done to know the following:

-  The number and components of white blood cells and red blood cells (cell count)

-  Albumin level

-  Gram stain and culture for any possible organisms

-  Amylase level

-  Glucose

-  Total protein

-  Cytology (the study of any cells in the fluid looking for malignant or cancerous cells)

15.  As soon as fluid is analysed by the laboratory, your doctor will do the analysis of result in order to determine the possible cause of ascites.

Prevention of Ascites:

You can not prevent ascites. But you can minimise the risk of developing ascites. By following the healthy habits you can reduce the risk of ascites. Check out the various healthy habits that will help you to reduce the risk of ascites:

1.   Cirrhosis is the problem of scarring of the liver. This problem majorly leads to ascites. The problem in liver occurs due to the more consumption of alcohol. That is why you should drink alcohol in moderation.

2.   Hepatitis B can lead to liver damage which is a major cause of ascites. So, getting vaccinated for hepatitis B can reduce the risk of developing ascites.

3.   Patients suffering from cirrhosis should limit the intake of nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin, etc.) as they may diminish the blood flow to the kidneys leading to limit the salt and water excretion.

4.   Hepatitis can be spread sexually so you should practice safe sex.

5.   Hepatitis can be transmitted through shared needles so you should avoid intravenous drug use.

6.   Before taking any medication, you should know its side effects.

Treatment of Ascites:

The treatment depends on the underlying cause of ascites. Various treatment options available for the patients:

1. Diet: Patients suffering from ascites due to cirrhosis should limit the intake of sodium, especially if they are on diuretics. It is recommended to the patients suffering from ascites to restrict dietary sodium (salt) intake to less than 2 grams in a day. If you are suffering from ascites then you should consult with a nutrition expert as they can guide you regarding the intake of dietary sodium.

2. Diuretics: Diuretics are generally given to the patients suffering from ascites. Diuretics are given to increase the amount of salt and water which helps your body to reduce pressure within the veins around the liver. Your doctor may monitor your blood chemistry when you are on diuretics. You should reduce the consumption of alcohol and intake of salt. As per diuretic regimen, it is recommended to have a combination of spironolactone (Aldactone) and furosemide (Lasix). A single dose of 100 milligrams of spironolactone and 40 milligrams of furosemide is taken initially. After some time, this increases to 400 milligrams of spironolactone and 160 milligrams of furosemide to achieve an appropriate response. This amount of dosage is given as long as it does not have any side effects on the patient.

3. Paracentesis: In this procedure, a thin and long needle is used to remove the excess amount of fluid accumulated in the abdomen. The needle is inserted into the abdominal cavity through the skin. If you are undergoing the procedure of paracentesis then your doctor may ask you to have the antibiotics as there is a risk of infection in this procedure. If your ascites is severe or occurring repeatedly then this treatment will be given to you to reduce the amount of excess fluid from the abdomen. Around 4 - 5 litres of fluid can be removed safely with the help of this treatment. Also in the last stage cases, this treatment is given as diuretics do not work.

4. Surgery: If your case is extreme then you may have to undergo a surgery. In surgery, a permanent tube known as shunt is implanted in your body. This tube helps to reroute blood flow around the liver. This procedure is associated with some complications or risks including hepatic encephalopathy and even death. If your ascites does not respond to treatment then your doctor may recommend you to get your liver transplant. This generally happens in the end-stage of liver disease.

5. Liver transplant: This is the ultimate solution for the end-stage of liver disease. This treatment is for those who are suffering from the ascites due to advanced cirrhosis. Liver transplantation is a complicated process which takes a long time. This process needs close monitoring and management by the transplant specialists.

Complications Of Ascites

1.  Sometimes, complications arise in ascites due to excess fluid accumulation. Due to excess accumulation of fluid, people can face the difficulty in breathing.

2.  Another serious complication of ascites is infections. Spontaneous bacterial peritonitis is an infection that can occur due to ascites fluid. This infection can threaten your life.

3.  In some cases, surgery is done when the case of ascites is extreme. The surgical procedure can lead to various complications including hepatic encephalopathy and even death.

4.  Weight loss, protein malnutrition, mental confusion, and change in the level of alertness are some of the other complications of ascites.

5.  Advanced cirrhosis of the liver can lead to kidney failure. The problem of kidney failure is known as the hepatorenal syndrome. This condition occurs rarely but it is a major complication as it may lead to kidney failure.

6.  Ascetics may lead to the problem of hepatic hydrothorax in which abdominal fluid fills the lung generally on the right side. Due to hepatic hydrothorax, you may suffer from the shortness of breath, cough, hypoxemia and/or discomfort in the chest. This problem can be treated with the help of paracentesis in which excess fluid is withdrawn.

Conclusion

Ascites occurs due to the accumulation of fluid in the abdominal cavity. Generally, people face this problem due to damage to the liver. Cirrhosis which is a problem of the liver is the major risk factor that can lead to ascites. You can reduce the risk of ascites by a healthy lifestyle. You should reduce the intake of alcohol and beverages containing caffeine. You should reduce the intake of salt. The treatment of ascites depends on the underlying cause of the problem. Ascites can be treated with the help of medications, surgery, diuretics, and paracentesis. There are various complications that are associated with ascites. Ascites can lead to a major complication sometimes even death if not treated on time or left untreated. Spontaneous bacterial peritonitis is a life-threatening infection that can occur due to ascites fluid. As soon as you experience the symptoms of ascites, you should reach out to the best doctor.

If you are looking for meaning, causes, symptoms, diagnosis, prevention, treatment, and complications of ascites then you are in the right place. Please do scroll up the page.

Last updated on : 20-09-2018

Disclaimer : Docprime doesn’t endorse or take any guarantee of the accuracy or completeness of information provided under this article and these are the views strictly of the writer. Docprime shall not be held responsible for any aspect of healthcare services administered with the information provided on this article.

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