Ascites

Ascites is the build-up of fluid in the stomach, as a result of severe liver disease. The extra fluid makes the abdomen swell up. This extra build-up usually occurs between the two membrane layers that together make up the peritoneum, a smooth sac that houses the body’s organs. It is, however, usual to have a small amount of fluid in the peritoneum cavity.

Ascites is discomforting and cause nausea, tiredness, breathlessness, and a feeling of being full. Liver disease is the commonest cause of ascites. Other possible causes are cancer and heart failure.

Ascites diagnosis is of multiple approaches. 

• Physical examination of the abdomen for swelling.
• Blood tests: To assess the function of the liver and the kidney.
• Fluid sample analysis: To ascertain diseases, like cancer or infection.
• Imaging Test: To see the inside of the abdomen. These include ultrasound, MRI, and CT scan.
• Laparoscopy.
• Angiography.

Ascites treatment 

Ascites treatment depends on the underlying cause.

• Diuretics: This is one of the most commonly used means for ascites treatment and is effective for most people with the condition. These drugs increase the quantity of salt and water leaving the body, thereby reducing the pressure within the veins around the liver.
• Paracentesis: For this procedure, a thin long needle is used to remove the surplus fluid. This treatment option is often used when the ascites is severe or recurrent. 
• Surgery: In life-threatening cases, a permanent tube known as a shunt is implanted in the body. It redirects blood flow around the liver. A liver transplant may also be recommended if ascites don’t respond to treatment. This is largely used for end-stage liver disease.
• Chemotherapy: This may help to shrink or control cancer. It is administered through a tube in the abdomen. This can sometimes stop fluid build-up.

Symptoms

Ascites symptoms don’t always hint of emergency, but it’s advisable to see a doctor if one experiences any of the following:

• A distended or swollen abdomen.
• Sudden weight gain.
• Difficulty with breathing when lying down.
• Diminished appetite.
• Abdominal pain.
• Bloating.
• Nausea and vomiting.
• Heartburn.
• Tiredness.
• Urinary urgency and constipation.
• Swelling in legs and ankles.
• Fever.
• Hernia.
• Indigestion.

Causes

The primary cause of ascites is liver scarring, known as cirrhosis. Scarring raises the pressure inside the liver’s blood vessels, which in turn may force fluid into the abdominal cavity. Thereby, resulting in ascites. Other causes of ascites due to liver problems may be:

• Viral hepatitis (B or C).
• Acute liver failure.
• Budd-Chiari syndrome: caused by blockage of the hepatic veins.
• Cancer that has metastasized or spread to the liver can also be the source of ascites.

Other primary causes of ascites are 

• Heart failure.
• Cancer: Ascites is likely to develop if cancer affects the peritoneum, lymphatic system, ovaries, breast, bowel, stomach, pancreas, lung and womb.

Underlying diseases responsible for ascites are 

• Tuberculosis. 
• Kidney disease. 
• Pancreatitis.
• Nephrotic syndrome.

FAQ

What are the risk factors of ascites?

The single biggest risk factor for ascites is liver damage. This may be due to cirrhosis, hepatitis B or C or a history of alcohol abuse.

Other possible risk factors for ascites include:

• Ovarian, pancreatic, liver or endometrial cancer.
• Heart or kidney failure.
• Pancreatitis.
• Tuberculosis.
• Hypothyroidism.
• Cancer in organs in the abdominal area.
• Kidney failure.
• Congestive heart failure.

Are there any complications that arise from ascites? 

Complications associated with ascites may include:

• Abdominal pain.
• Pleural effusion (water on the lung). This can lead to difficulty in breathing.
• Hernias; like inguinal hernias.
• Bacterial infections.
• Hepatorenal syndrome; a rare kind of progressive kidney failure.
• Difficulty in eating, drinking and moving around.

What is the long term outlook of ascites?

The prognosis and long term outlook of ascites depend on the underlying condition. While symptoms can be managed and reduced, the treatment of the underlying cause of ascites is what determines the outcome.

Presently, there is no satisfactory treatment for people who have cirrhosis. 

Paracentesis and shunts not accompanied by a liver transplant may improve a person’s quality of life, but are not seen to improve long-term life expectancy significantly.

What are the tips that can prevent ascites?

The development of ascites can’t, unfortunately, be prevented. However, its risks can be reduced by protecting the liver. 

You can try adopting these healthy habits:

• Quit alcohol consumption: This can go a long way to help prevent cirrhosis.
• Hepatitis B vaccination.
• Avoid sharing needles, as Hepatitis can be transmitted through shared needles.
• Know the potential side effects of the medications you consume.