Ascites

Ascites

Ascites is the abnormal accumulation of fluid in the abdominal cavity, usually due to liver disease, cancer, or heart failure. It is a common complication of cirrhosis, where increased pressure in the liver’s blood vessels (portal hypertension) and reduced protein production lead to fluid leakage into the abdomen.

Causes of Ascites

Ascites can result from various medical conditions, including:

1. Liver-Related Causes (Most Common)

• Cirrhosis – The leading cause due to portal hypertension and low albumin levels.

• Liver Cancer (Hepatocellular Carcinoma) – Cancerous growth affects liver function.

• Acute Liver Failure – Rapid loss of liver function leading to fluid imbalance.

2. Cancer-Related Causes

• Peritoneal Carcinomatosis – Cancer spreads to the abdominal lining.

• Ovarian, Pancreatic, or Stomach Cancer – Tumors can obstruct fluid drainage.

3. Heart & Kidney Diseases

• Congestive Heart Failure (CHF) – Leads to fluid buildup due to poor circulation.

• Nephrotic Syndrome – Kidney dysfunction causing excessive protein loss.

4. Infections & Other Causes

• Tuberculosis (TB Peritonitis) – Infection leading to fluid accumulation.

• Pancreatitis – Inflammation causing leakage of digestive fluids.

Symptoms of Ascites

The severity of symptoms depends on the amount of fluid accumulation. Common symptoms include:

• Abdominal swelling and bloating.

• Increased abdominal size (distension).

• Shortness of breath (due to pressure on the diaphragm).

• Loss of appetite and early satiety (feeling full quickly).

• Weight gain (due to excess fluid).

• Fatigue and weakness.

• Nausea and indigestion.

• Swelling in the legs and feet (Edema).

Complications of Ascites

If untreated, ascites can lead to severe complications, such as:

• Spontaneous Bacterial Peritonitis (SBP) – A life-threatening infection of the abdominal fluid.

• Hepatorenal Syndrome (HRS) – Kidney failure due to severe liver dysfunction.

• Severe Breathing Difficulty – Due to increased abdominal pressure.

Diagnosis of Ascites

• Physical Examination – Doctors check for abdominal swelling and fluid wave.

• Ultrasound or CT Scan – Confirms fluid accumulation and detects underlying causes.

• Paracentesis (Fluid Tap) – A needle is used to remove and analyze the fluid for infection, cancer cells, or protein levels.

• Liver Function Tests (LFTs) – Evaluates liver disease.

Treatment for Ascites

While mild ascites can be managed with dietary changes and medication, severe cases may require medical procedures:

1. Lifestyle & Dietary Changes

• Low-Sodium Diet (<2g per day) – Reduces fluid buildup.

• Limit Fluid Intake – For patients with severe fluid retention.

• Avoid Alcohol – Prevents further liver damage.

2. Medications

• Diuretics (Water Pills) – Help remove excess fluid:

  • Spironolactone & Furosemide – Commonly used diuretics.

• Antibiotics – If infection (SBP) is present.

3. Medical Procedures

• Paracentesis – A procedure to drain excess fluid using a needle, providing immediate relief.

• Transjugular Intrahepatic Portosystemic Shunt (TIPS) – A procedure to reduce portal hypertension by creating a bypass in the liver’s blood flow.

• Liver Transplant – The only definitive cure in cases of end-stage liver disease.

Prevention of Ascites

• Manage underlying liver disease (Cirrhosis, Hepatitis B/C).

• Avoid alcohol and hepatotoxic medications.

• Follow a healthy diet and exercise regularly.

• Monitor and treat heart or kidney disease.

Ascites is a serious condition that requires prompt medical attention. Proper management, lifestyle modifications, and treatment of the underlying cause can help improve outcomes and prevent complications.