Ascites : causes, diagnosis and treatment

Ascites is defined as the build-up of fluid in the abdomen. This buildup occurs between two membrane layers that together make up the peritoneum, a smooth sac that contains the body’s organs. It is not everybody who has an enlarged abdomen that is suffering from ascites. Abdominal fat, pregnancy, fibroid, stomach or intestinal gas, can all lead to an enlarged abdomen, but when a build up of fluid is the cause of the abdominal enlargement, then we can say that the person has ascites. To have a small amount of fluid in the peritoneal cavity may not become obvious to you or your doctor at first, but it becomes a problem when there is an increase in the fluid build up in the peritoneum.

Ascites is very uncomfortable and causes nausea, tiredness, breathlessness, and a feeling of being full. Liver disease is the most common cause of ascites. Other causes typically include cancer and heart failure.



Signs and Symptoms

Ascites can be gradual and is usually accompanied by a feeling of fullness, a ballooning belly, and rapid 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 and occurs most often with cirrhosis.

Causes of Ascites

It results from high pressure in the blood vessels of the liver (portal hypertension) and low levels of a protein called albumin. Diseases that can cause severe liver damage can lead to ascites. These include:

  • Chronic hepatitis C or B infection
  • Alcohol abuse over many years
  • Fatty liver disease (non-alcoholic steatohepatitis or NASH)
  • People with certain cancers in the abdomen may develop ascites. These include cancer of the appendix, colon, ovaries, uterus, pancreas, and liver.

Other conditions that can cause this problem include:

  • Clots in the veins of the liver (portal vein thrombosis)
  • Congestive heart failure
  • Pancreatitis
  • Thickening and scarring of the sac-like covering of the heart (pericarditis)

Kidney dialysis may also be linked 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. If your doctor thinks you have ascites, your doctor will use a needle to remove fluid from your abdomen for testing. This procedure is called a paracentesis. It will help your doctor determine the cause of your condition, so it can be properly treated.

In most cases of ascites, your doctor will refer you to a liver specialist, who may discuss a liver transplant.

Complications associated with ascites include:

  • Abdominal pain.
  • Pleural effusion, or “water on the lung”; this can lead to difficulty breathing.
  • Hernias, such as inguinal hernias.
  • Bacterial infections, such as spontaneous bacterial peritonitis (SBP).
  • Hepatorenal syndrome, a rare type of progressive kidney failure.


Treatment is a combination of diet and lifestyle changes, medication and paracentesis. The underlying cause will need to be treated as well. Your doctor will ask you to reduce your salt intake and stay away from alcohol consumption as part of the diet and lifestyle changes.

Your doctor may also prescribe “water pills,” also called diuretics, to help flush the extra fluid from your body. Two of the most common diuretics are Furosemide (Lasix) and Spironolactone (Aldactone). They both help your kidneys remove more sodium and water.

If changes in diet and prescription diuretics aren’t effective, or your symptoms are severe, your doctor may have to use paracentesis to remove large amounts of excess fluid through a needle inserted into your abdomen. This procedure must be combined with a low-salt, low-liquid diet, otherwise the fluid will simply come back.

If these treatments don’t work, you may need a surgery to place a shunt in your liver or replace it altogether.

Preventive Measures You Can Take

Ascites can’t be prevented. However, you can lower your risk of ascites by protecting your liver. Try adopting these healthy habits:

  • Get vaccinated for hepatitis B.
  • Practice having safe sex with a condom. Hepatitis can be sexually transmitted.
  • Avoid sharing needles. Hepatitis can be transmitted through shared needles.
  • Know the potential side effects of your medications. If liver damage is a risk, talk to your doctor about whether your liver function should be tested.
  • Weigh yourself daily. Call your doctor if you gain more than 10 lbs (or more than 2 lbs per day on 3 consecutive days).
  • 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). Ibuprofen (Advil®, Motrin®), aspirin, indomethacin, sulindac are examples of NSAIDs. These drugs affect the kidneys, causing water and salt to be retained by the body.
  • Follow guidelines for a low-salt diet. Recommended limits are 2,000 mg or less a day.




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