Ascites is the buildup of an abnormal amount of fluid inside the abdomen (belly). This is a common problem in patients with cirrhosis (scarring) of the liver. Approximately 80% of patients with cirrhosis of the liver develop ascites.
Most people who develop ascites develop a large belly and experience a rapid gain in weight. Some people also develop swelling of the ankles and shortness of breath.
Ascites is the end result of a series of events. Cirrhosis of the liver is the most common cause of ascites. When cirrhosis occurs, blood flow through the liver is blocked. This blockage causes an increase in the pressure in the main vein (the portal vein) that delivers blood from the digestive organs to the liver. This condition is called portal hypertension. Ascites occurs when portal hypertension develops. The kidneys cannot rid the body of enough sodium (salt) through urine. Not being able to rid the body of salt causes fluids to build up in the abdomen, resulting in ascites.
Common risk factors for the development of ascites are any diseases that can cause cirrhosis of the liver. These include hepatitis B, hepatitis C, and alcoholism/alcohol abuse. Other diseases that lead to fluid buildup are congestive heart failure and kidney failure. Cancers of organs in the abdomen also may lead to ascites.
Ascites is diagnosed based on physical exam, medical history, blood tests, ultrasound or CT scan, and paracentesis. Paracentesis is a procedure in which a needle is inserted through the abdominal wall (after local anesthesia) and fluid is removed. This fluid is examined for signs of infection, cancer, or other medical problems.
Limit the amount of salt in your diet. The most important step to treating ascites is to drastically reduce your salt intake. Recommended limits are 2,000 mg or less a day. Seeing a nutritional specialist (dietitian) is helpful especially because the salt content in foods is difficult to determine. Salt substitutes – that do not contain potassium -- can be used.
Often, patients will require diuretics (“water pills”) to treat ascites. Take these pills as prescribed. Common diuretics are spironolactone (Aldactone®) and/or furosemide (Lasix®). These water pills can cause problems with your electrolytes (sodium, potassium) and kidney function (creatinine). Taking water pills is not a substitute for reducing your salt intake. Both are needed to treat ascites.
Other, increasingly more aggressive treatments include:
Paracentesis as a treatment: Sometimes fluids continue to build up in the abdomen despite use of diuretics and a restricted salt diet. In these cases, patients may need paracentesis to remove this large amount of excess fluid.
Surgery: Surgical placement of a shunt (tube) between the main vein (portal vein) and smaller veins is sometimes used as a treatment. A radiologist can place a shunt directly through the liver, thereby relieving portal hypertension and diminishing ascites. By increasing blood flow, all organs of the body are better able to perform their function. For example, in patients with ascites, improved kidney function helps rid the body of excess sodium (salt) and prevent the buildup of fluids.
Liver transplant: This approach is reserved for patients with very severe cirrhosis whose livers are failing.
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