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Ascites by Krisha McCoy, MS

Definition

Ascites is the accumulation of excess fluid in the abdominal cavity. This condition can be treated, so if you think you have ascites, contact your doctor.

Ascites

Causes

Ascites is usually caused by liver disorders, including:

Cirrhosis —a disease in which the liver becomes permanently damaged
Chronic hepatitis —an infection of the liver
Severe alcoholic hepatitis without cirrhosis
Obstruction of the hepatic vein (a blood vessel of the liver)

It can also be caused by:

Risk Factors

These factors increase your chance of developing ascites. Tell your doctor if you have any of these risk factors:

Alcoholism
Hepatitis B or C

Symptoms

If you experience any of these symptoms do not assume it is due to ascites. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Increased abdominal circumference
Shortness of breath
Abdominal pain and/or distention
Pain in the side abdomen
Rapid weight gain
Difficulty breathing while lying flat
Decreased appetite
Heartburn

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:

Ultrasound —a test that uses sound waves to examine the abdominal cavity
CT scan —a type of x-ray that uses a computer to make pictures of structures inside the abdominal cavity
MRI scan —a test that uses magnetic waves to make pictures of structures inside the abdominal cavity
Laparoscopy —a thin, lighted tube inserted through a small incision in the abdomen to look at the structures inside the abdominal cavity
Blood tests—to determine liver and kidney function as well as evidence of other problems that may lead to ascites
Liver biopsy —removal of a sample of liver tissue for testing
Angiography —x-rays taken after a dye is injected into the arteries to better view the area being examined
Abdominal paracentesis —removal and testing of fluid from the abdominal cavity

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Dietary Changes

Sodium restriction—Limiting salt intake to 2,000 mg per day or less is often recommended to reduce or delay fluid build-up. More extreme restrictions in salt intake do not further improve outcomes.
Alcohol restriction—Ascites commonly occurs in people who have liver disease. Consuming alcohol can further impair liver function. Stopping alcohol use may limit the progression of ascites.

Diuretics (Water Pills)

Diuretic medications are drugs that cause the kidneys to excrete more sodium and water in the urine. These medications are often recommended as the treatment of choice for ascites, along with sodium restriction.

Examples of diurectics include:

Spironolactone (Aldactone)
Furosemide (Lasix)

Paracentesis

Ascites can be treated by inserting a hollow needle into the abdomen and removing excess fluid through the needle.

Surgery

If the other treatments are not effective and the ascites keep coming back, surgery can be done to divert blood away from the liver.

If you are diagnosed with ascites, follow your doctor's instructions .

Prevention

To decrease the risk of ascites, take the following steps to prevent cirrhosis, the most common cause of ascites:

Drink alcohol in moderation. This means no more than one drink per day for women and two for men.
Practice safe sex to avoid hepatitis.
Do not share intravenous (IV) needles.
Get vaccinated for hepatitis B .
If you are taking medications that can damage your liver, follow your doctor's guidelines on getting your blood tested.

If you have had ascites, you can prevent their reoccurrence by:

Not drinking alcohol
Limiting your use of all medications, including over-the-counter drugs (unless recommended otherwise by your doctor)
Restricting your sodium intake
Taking diuretics as recommended by your doctor

RESOURCES:

American Liver Foundation http://www.liverfoundation.org/
National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Liver Foundation http://www.liver.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

Ascites. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed January 28, 2009.
Ascites. Merck website. Available at: http://www.merck.com/mmhe/sec10/ch135/ch135e.html . Accessed January 28, 2009.
Cesario K, Carey WD. Ascites. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/diseasemanagement/gastro/ascites/ascites.htm . Accessed January 28, 2009.

Last reviewed March 2013 by Daus Mahnke, MD

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