DefinitionAscites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).See also:Alcoholic liver diseaseCirrhosis
Alternative NamesPortal hypertension - ascites
Causes, incidence, and risk factorsA person with ascites usually has severe liver disease. Ascites due to liver disease is caused by high pressure in the blood vessels of the liver (portal hypertension) and low albumin levels.Cirrhosis and any illness that leads to it is a common cause of ascites. Long-term infections with hepatitis C or B and long-term alcohol abuse are two of the most common causes of cirrhosis.People with colon cancer, ovarian cancer, endometrial cancer, pancreatic cancer, and liver cancer may develop ascites. Other conditions which may lead to this problem include:Disorders that may be associated with ascites include:Clots in the veins of the liver (portal vein thrombosis)Congestive heart failurePancreatitisThickening and scarring of the sac like covering of the heart Kidney dialysis may also be associated with ascites.
SymptomsWhen just a small amount of fluid has collected in the belly, there may be no symptoms. Symptoms often develop slowly or suddenly, but a rapid buildup of fluid and symptoms may occur with some causes of ascites.As more fluid collects, abdominal pain and bloating may occur. When a large amount of ascites is present shortness of breath may develop also.
Signs and testsA physical examination may reveal a swollen abdomen, or belly.Test to evaluate the liver may be done, including:24-hour urine collectionCreatinine and electrolytesKidney function testsLiver enzyme, bilirubin, coagulation, and serum protein testsUrinalysisParacentesis or abdominal tap may be performed. This procedure involves using a thin needle to pull fluid from the abdomen. The fluid is tested in various ways to determine the cause of ascites.
TreatmentThe condition that causes ascites will be treated, if possible.Treatment may include:Diuretics, or "water pills," to help remove the fluid; usually, spironolactone (Aldactone) is used first, and then furosemide (Lasix) will be addedAntibiotics, if an infection developsLimiting salt in the diet (no more than 1,500 mg/day of sodium)Avoiding drinking alcoholProcedures used for ascites that do not respond to medical treatment include:Placing a tube into the area to remove large volumes of fluid (called a large volume paracentesis)Transjugular intrahepatic portosystemic shunt (TIPS), which helps reroute blood around the liverPatients who develop end-stage liver disease, and whose ascites no longer respond to treatment will need a liver transplant.
ComplicationsSpontaneous bacterial peritonitis (a life-threatening infection of the ascites fluid)Hepatorenal syndrome (kidney failure)Weight loss and protein malnutritionMental confusion, change in the level of alertness, or coma (hepatic encephalopathy)Other complications of liver cirrhosis
Calling your health care providerAnyone who has ascites and develops new abdominal pain and fever should contact their health care provider immediately.
ReferencesRunyon BA; AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49(6):2087-2107.Mehta G, Rothstein KD. Health maintenance issues in cirrhosis.Med Clin North Am. 2009;93:901-915.Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds.Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.