What is ascites?
Ascites is a serious condition in which there is an abnormal accumulation of fluid under the lining (peritoneum) of the abdominal cavity that builds up around the abdominal organs. Ascites is characterized by a swollen abdomen and weight gain. This can be accompanied by abdominal pain or discomfort, difficulty breathing, and ankle swelling.
Cirrhosis of the liver is the most common cause of ascites. Cirrhosis of the liver is the development of scar tissue in the liver and permanent damage caused by liver disease, most often by alcoholism. When liver damage and scarring become extensive and cause the liver to become hard, normal blood flow to and from the liver is restricted, resulting in high blood pressure in the portal vein (portal hypertension). The portal vein is one of the largest and most important veins in the abdomen. It brings blood to the liver to be filtered. When portal hypertension occurs, blood backs up and causes fluid (ascites) to leak into the abdominal cavity. Portal hypertension causes other serious complications as well, such as esophageal varices (swollen veins in the esophagus that can rupture and hemorrhage). Ascites itself can cause other serious and life-threatening complications. Those individuals with cirrhosis who do not have portal hypertension do not develop ascites. Scarring of the liver caused by cirrhosis of the liver cannot be reversed or cured. However, following an effective treatment plan may help you slow or stop progression of the disease and prevent or minimize ascites.
Cirrhosis of the liver, the leading cause of ascites, critically affects the liver’s ability to function normally and can result in serious, potentially life-threatening complications, such as portal hypertension, liver failure, hemorrhage, and kidney failure. Seek prompt medical care if you have a history of hepatitis, alcoholism, liver disease, or other chronic diseases, or if you have unexplained symptoms, such as nausea, fatigue, diarrhea or weakness. Early diagnosis and treatment can reduce your risk of serious complications.
In addition, if you have cirrhosis of the liver, do not take any supplements, over-the-counter medications, or prescription drugs without consulting your health care provider. The liver may not be able to clear the drugs from the body, which can lead to dangerous, toxic levels of chemicals or substances in the body.
Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of advanced cirrhosis, liver failure, or other complications of cirrhosis of the liver. Symptoms include inability to produce urine, confusion, shortness of breath, jaundice, heavy rectal bleeding, vomiting blood, or a change in consciousness or alertness.
What are the symptoms of ascites?
The main symptom of ascites is a swollen or distended abdomen due to fluid buildup. Other symptoms may include:
Abdominal pain or discomfort
Jaundice (yellowing of the skin and whites of the eyes)
Unexplained weight gain
Symptoms that might indicate a serious or life-threatening condition
Ascites is a very serious condition that often indicates cirrhosis of the liver, advanced liver disease, congestive heart failure, cancer, or other life-threatening conditions and complications. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms:
Chest pain or discomfort
Loose, wet cough with frothy phlegm and possibly blood-tinged phlegm
Personality changes and poor cognitive functioning due to the inability of the liver to filter toxins and a buildup of waste products in the blood and brain
Shortness of breath, difficulty breathing, wheezing, or other unusual breathing noises
What causes ascites?
Cirrhosis of the liver is the most common cause of ascites. Cirrhosis of the liver is caused by an underlying disease or condition that results in inflammation and the formation of permanent scarring (fibrosis) of liver tissue and hardening of the liver. Permanent liver scarring obstructs and decreases blood flow through the blood vessels to and from the liver. This leads to the development of high blood pressure in the portal vein (portal hypertension).
The portal vein is a large vein in the abdomen that brings blood to the liver to be filtered. Portal hypertension causes blood to back up, which forces fluid from the blood vessels to leak into the abdominal cavity (ascites), and other serious problems.
Hepatic (liver) causes of ascites
Diseases and conditions that can cause scarring of the liver, cirrhosis and ascites include:
- Alcohol abuse and alcoholism
- Autoimmune hepatitis (form of hepatitis in which the immune system attacks the liver)
- Chronic hepatitis B or C
- Cystic fibrosis (inherited disease that causes a buildup of mucus in the liver, lungs, and other organs)
- Glycogen storage diseases
- Hemochromatosis (excessive levels of iron in the body that cause liver damage)
- Liver cancer (hepatocellular carcinoma)
- Metastatic cancer seeding the liver
- Secondary biliary cirrhosis
Wilson’s disease (inherited disease that causes excessive retention of copper and liver damage)
Other causes of ascites
Other than cirrhosis of the liver, causes of ascites include:
Blood clot in the portal or hepatic vein
Congestive heart failure (severe deterioration of the heart’s ability to pump blood, resulting in potentially life-threatening congestion in the lungs and other tissues of the body)
Kidney failure (severe deterioration of kidney function, resulting in a buildup of waste and fluid in the body as well as other serious problems)
A number of factors increase the risk of developing cirrhosis of the liver, the most common cause of ascites. Risk factors include:
Alcohol abuse and alcoholism
Chronic hepatitis B, C or D
Coronary artery disease
Diabetes (chronic disease that affects your body’s ability to use sugar for energy)
Exposure to certain toxins such as arsenic
High triglyceride levels
Intestinal bypass surgery
Long-term treatment with corticosteroids
Reducing your risk of ascites
You can lower your risk of developing some conditions that cause ascites by:
Not drinking alcohol or limiting alcohol intake to one drink per day for women and two drinks per day for men
How is ascites treated?
Treatment for ascites often includes a multifaceted and individualized approach that involves directly treating the excess fluid as well as treating the underlying disease that caused the ascites, such as cirrhosis of the liver, congenital heart disease, or kidney failure. Merely draining the ascites fluid from the abdomen only provides temporary relief.
Treatment for ascites
Treatment of ascites can include:
Antibiotics to treat an infection called bacterial peritonitis (infection of the lining that surrounds the abdominal organs)
Decreased consumption of high-sodium foods and beverages to reduce fluid retention
Diuretics (such as triamterene) to reduce fluid retention
Paracentesis to remove ascites fluid with insertion of a tube
Placement of a TIPS (transjugular intrahepatic portosystemic shunt) to treat ascites caused by portal hypertension. The shunt allows blood to bypass a damaged liver. TIPS placement is a minimally invasive procedure performed through the jugular vein in the neck.
Treatment for the underlying causes of ascites
Ascites is most commonly caused by cirrhosis of the liver. Treatment of cirrhosis includes efforts to stop or slow the progression of damage to the liver and minimize and quickly treat any complications, such as liver failure and hemorrhage. Treatment for liver failure may include liver transplant, which is a major surgical procedure to replace a severely diseased liver with healthy donor liver.
Treatment plans for cirrhosis of the liver also involve treating the underlying cause of the cirrhosis. For example:
Treatment of alcoholism includes abstaining from alcohol, which often requires participation in an alcohol treatment program.
Complications of ascites and the underlying causes of ascites are serious and life threatening. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of ascites include:
Malnutrition and weight loss
Permanent liver damage and loss of normal liver function
Spontaneous bacterial peritonitis