Ascites

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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.

Less often, congestive heart failure and kidney failure can also cause ascites. In rare cases, pancreatitis, certain types of cancer, and other conditions can lead to 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:

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:

  • Bleeding, such as vomiting blood, bloody stools or major rectal bleeding

  • Chest pain or discomfort

  • Confusion, disorientation, or change in consciousness, such as lethargy, decreased alertness, unresponsiveness or passing out

  • 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)
  • 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)
  • 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

  • Certain cancers, such as ovarian cancer, colon cancer and pancreatic cancer

  • 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)

  • Nephrotic syndrome (type of kidney disease)

  • Pancreatitis

What are the risk factors for ascites?

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

  • Kidney disease

  • Long-term treatment with corticosteroids

  • Obesity

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

  • Seeking regular medical care and following your treatment plan for chronic diseases and conditions, such as cirrhosis of the liver, diabetes, obesity, high cholesterol, and coronary artery disease

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.

  • Treatment of hepatitis may include corticosteroid drugs for autoimmune hepatitis or the medication interferon to treat a hepatitis infection.

What are the potential complications of ascites?

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:

  • Esophageal varices

  • Heart failure

  • Hepatic encephalopathy

  • Hepatic hydrothorax

  • Hernia

  • Kidney failure

  • Liver cancer

  • Liver failure

  • Malnutrition and weight loss

  • Permanent liver damage and loss of normal liver function

  • Spontaneous bacterial peritonitis

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 19
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  2. Ascites: A Common Problem in People with Cirrhosis. http://www.acg.gi.org/patients/gihealth/ascites.asp
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  4. Cirrhosis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001301/.
  5. Portal Hypertension. http://vasculardisease.org/portal-hypertension/.
  6. Runyon BA, AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49:2087.