Ascites

Ascites is a medical term for swelling caused by the buildup of fluid in the abdomen, often due to liver disease. Pronounced “uh-sigh-teez,” ascites places pressure on surrounding organs including the lungs, kidneys and heart. Many serious health conditions can cause ascites, such as congestive heart failure, blood clots in the liver’s portal vein, inflammation of the pancreas called pancreatitis, or cancers such as ovarian, breast or bowel.  

The most common cause of ascites is liver disease. Damage to the liver results in decreased liver function and increased blood pressure inside the portal vein, a condition called portal hypertension. Some of the liver diseases that can lead to ascites include:

• chronic hepatitis B or hepatitis C
• cirrhosis, or liver scarring, caused by genetic disorders
• long-term alcohol abuse
• nonalcoholic fatty liver disease, or NAFLD

Signs and Symptoms of Ascites

Ascites does not always cause symptoms at first if there is only a small amount of fluid. Depending on the underlying cause, symptoms of worsening ascites may develop gradually or quickly and may include:

• abdominal bloating
• discomfort when eating, sitting or moving around
• fatigue
• nausea and vomiting
• pain in the abdomen
• rapid weight gain
• shortness of breath
• swelling in legs and ankles
• umbilical hernia, caused when abdominal pressure pushes a loop of intestine through an opening in the muscle near the belly button

In addition, ascites is associated with an increased risk of developing life-threatening complications such as:

• hepatorenal syndrome — impaired kidney function due to advanced liver disease
• pleural effusion — fluid accumulation in the space between the lungs and ribs
• spontaneous bacterial peritonitis — a severe abdominal infection

How Is Ascites Diagnosed?

In addition to a physical examination and review of symptoms, abdominal ultrasound can confirm the presence of ascites. 

To find the underlying cause of ascites other tests may be needed, such as:

• analysis of small sample of fluid from the abdomen
• blood tests to look for signs of disease
• imaging studies such as a computed tomography scan
• kidney function tests
• liver function tests
• urinalysis

Treatments for Ascites

Treatment for ascites focuses on relieving symptoms and minimizing the risk of complications. Additional treatment may be needed for the underlying cause. Options for mild ascites include:

• strictly limiting intake of salt, which causes the body to retain fluid
• diuretic medications, such as furosemide and spironolactone, to help flush excess fluid from the body

While many cases of ascites respond well to dietary changes and medication, some cases are more complex to treat. More intensive treatment options include:

• paracentesis — a procedure in which fluid is drained from the abdomen
• transjugular intrahepatic portosystemic shunt — a non-surgical procedure in which a small device is placed in the portal vein to improve blood flow

For ascites caused by advanced liver disease, a liver transplant may be considered when all other treatment options have been tried without success. Not sure where internal links should go; CHRISTUS looks like it has multiple hospitals.