Ascites
Ascites refers to the accumulation of an abnormal amount of fluid in the abdomen. This is a common issue in patients with liver cirrhosis and is often treated by reducing salt intake and using diuretic medications.
What is Ascites?
Ascites is the buildup of pathological fluid in the abdominal cavity, commonly seen in patients with liver cirrhosis. Approximately 80% of cirrhosis patients develop ascites.
What Causes Ascites?
Ascites is the result of several processes, with liver cirrhosis being the most common cause. In cirrhosis, blood flow through the liver is obstructed, leading to increased pressure in the portal vein, which carries blood from the digestive organs to the liver. This condition is called portal hypertension. As portal hypertension develops, the kidneys are unable to remove enough sodium from the body through urine, causing fluid to accumulate in the abdomen, resulting in ascites.
What are the Symptoms of Ascites?
The main symptoms of ascites include:
- A swollen, enlarged abdomen
- Rapid weight gain
- Some individuals may also experience ankle swelling and difficulty breathing.
How is Ascites Diagnosed?
Diagnosis of ascites involves a combination of:
- Clinical examination and medical history
- Blood tests
- Ultrasound or CT scan
- Paracentesis: A procedure in which a needle is inserted into the abdomen to remove fluid, which is then tested for signs of infection, cancer, or other medical conditions.
What are the Complications of Ascites?
- Abdominal pain and discomfort: Excess fluid can restrict the patient’s ability to eat, walk, and perform daily activities.
- Infection: Fluid accumulation can become infected, leading to spontaneous bacterial peritonitis (SBP), which typically causes fever and abdominal pain. It requires treatment with IV antibiotics and long-term oral antibiotics to prevent recurrence.
- Fluid in the lungs: Known as pleural effusion, where the abdominal fluid fills the lungs (often on the right side), leading to difficulty breathing, coughing, and chest discomfort.
- Kidney failure: Deteriorating liver cirrhosis can cause hepatorenal syndrome, a rare but severe condition that can lead to kidney failure.
What are the Best Treatments for Ascites?
- Limit salt intake: The most critical step in treating ascites is to significantly reduce sodium in the diet, often with the help of a dietitian.
- Diuretics: Common diuretics like spironolactone and/or furosemide are often used. These can affect electrolyte balance and kidney function, so they are not a substitute for reducing salt intake.
More Aggressive Treatments:
- Paracentesis: If fluid accumulation continues despite diet and diuretics, paracentesis may be needed to remove large amounts of excess fluid.
- Surgery: A surgical procedure may be used to insert a shunt between the portal vein and smaller veins, relieving portal hypertension and reducing ascites. This can improve kidney function and prevent fluid buildup.
- Liver transplantation: For patients with severe cirrhosis, liver transplant may be necessary.
Risk Factors for Ascites Development:
Common risk factors include conditions that can lead to liver cirrhosis, such as hepatitis B, hepatitis C, and alcohol abuse. Other diseases like heart failure, kidney failure, and abdominal cancers can also result in ascites.
Managing Ascites:
- Weigh yourself daily and contact your doctor if you gain more than 4 kilograms (or 1 kilogram per day over three consecutive days).
- Limit or completely avoid alcohol to reduce the risk of developing ascites.
- Minimize the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin, as they can affect kidney function, leading to water and salt retention.
- Follow a low-sodium diet as directed by your doctor.