Ascites (patient information)
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Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).
What are the symptoms of Ascites?
When 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.
What causes Ascites ?
Disorders that may be associated with ascites include:
- Clots in the veins of the liver (portal vein thrombosis)
- Congestive heart failure
- Thickening and scarring of the sac like covering of the heart
Kidney dialysis may also be associated with ascites.
A physical examination may reveal a swollen abdomen, or belly.
Test to evaluate the liver may be done, including:
- 24-hour urine collection
- Creatinine and electrolytes
- Kidney function tests
- Liver enzyme, bilirubin, coagulation, and serum protein tests
Paracentesis 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.
When to Contact a Medical Professional ?
Anyone who has ascites and develops new abdominal pain and fever should contact their health care provider immediately.
The 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 added
- Antibiotics, if an infection develops
- Limiting salt in the diet (no more than 1,500 mg/day of sodium)
- Avoiding drinking alcohol
Procedures 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 liver
Patients who develop end-stage liver disease, and whose ascites no longer respond to treatment will need a liver transplant.
- Spontaneous bacterial peritonitis (a life-threatening infection of the ascites fluid)
- Hepatorenal syndrome (kidney failure)
- Weight loss and protein malnutrition
- Mental confusion, change in the level of alertness, or coma (hepatic encephalopathy)
- Other complications of liver cirrhosis