By Dr Saravana K.
Ascites is the build-up of an abnormal amount of fluid inside the abdomen. Cirrhosis of the liver is the most common cause of ascites. When cirrhosis occurs, blood flow through the liver is blocked. This blockage causes an increase in the pressure in the main vein (the portal vein) that delivers blood from the digestive organs to the liver. This condition is called portal hypertension. Ascites occurs when portal hypertension develops. The kidneys cannot rid the body of enough sodium (salt) through urine. Not being able to rid the body of salt causes fluids to build up in the abdomen, resulting in ascites.
What are the risk factors for development of ascites?
Common risk factors for the development of ascites are any disease that can cause cirrhosis of the liver. These include hepatitis B, hepatitis C, and alcoholism/alcohol abuse. Other diseases that lead to fluid build-up are congestive heart failure and kidney failure. Cancers of organs in the abdomen also may lead to ascites.
How is ascites diagnosed?
Ascites is diagnosed based on physical exam, medical history, blood tests, ultrasound or CT scan, and paracentesis. Paracentesis is a procedure in which a needle is inserted through the abdominal wall (after local anesthesia) and fluid is removed. This fluid is examined for signs of infection, cancer or other medical problems.
What are the complications of ascites?
- Abdominal pain, discomfort and difficulty breathing:
- Spontaneous bacterial peritonitis: The fluids that build up in the gut could become infected with bacteria. It causes fever and abdominal pain. The diagnosis is generally made by performing a paracentesis. It requires treatment with IV antibiotics.
- Fluid in the lungs: This condition is called hepatic hydrothorax. Abdominal fluid fills the lung (mostly on the right side). This results in shortness of breath, cough, chest discomfort. Hepatic hydrothorax is best treated by removing the abdominal ascites by paracentesis.
- Kidney failure: Worsening of cirrhosis of the liver can lead to kidney failure. This condition is called hepatorenal syndrome. It is rare, but is a serious condition and may lead to kidney failure.
What are the best treatments for ascites?
- Limit the amount of salt in your diet. The most important step to treating ascites is to drastically reduce your salt intake. Recommended limits are 2,000mg or less a day.
- Often, patients will require diuretics (‘water pills’) to treat ascites.
- Paracentesis as a treatment: Sometimes fluids continue to build up in the abdomen despite use of diuretics and a restricted salt diet. In these cases, patients may need paracentesis to remove this large amount of excess fluid.
- Limit the amount of alcohol you drink. Better yet, do not drink any alcoholic beverages at all. Reducing the amount of alcohol you drink reduces the risk of developing ascites.
- Limit use of nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs affect the kidneys, causing water and salt to be retained by the body.
- Surgery: Surgical placement of a shunt (tube) between the main vein (portal vein) and smaller veins is sometimes used as a treatment. A radiologist can place a shunt directly through the liver, thereby relieving portal hypertension and diminishing ascites.
- Liver transplant: This approach is reserved for patients with very severe cirrhosis whose livers are failing.