Part UT Health San Antonio

Definition

Ascites is the buildup of excess fluid in the abdominal cavity.

Ascites
si55551253_96472_1_Ascites

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Causes

Ascites can be caused by:

  • High blood pressure in the liver's portal venous system, which can be caused by:
    • Liver damage called cirrhosis (most common cause)
    • Heart failure
    • Blockage of the large vein in the abdomen called the vena cava
  • Malnutrition or other conditions leading to low amounts of protein in the blood
  • Certain cancers
  • Infections, such as certain bacteria and parasites, or tuberculosis that can invade the abdomen
  • Pancreatitis
  • Kidney disease
  • Abdominal leakage of lymph fluid

Risk Factors

Factors that may increase your chance of ascites include having any of the conditions above.

Symptoms

Symptoms may include:

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

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Tests to determine cause may include:

Imaging tests look for the amount and distribution of fluid, and evaluate abdominal structures. These may include:

Treatment

Some treatments will vary according to what is causing the ascites. Talk with your doctor about the best treatment plan for you. Some options include:

Dietary Changes

  • Sodium restriction—Limiting salt intake to 2,000 mg (milligrams) per day or fewer is often recommended to reduce or delay fluid buildup. More extreme restrictions in salt intake do not help.
  • Fluid restriction—If sodium level is too low.
  • Alcohol restriction—Ascites commonly occurs in people who have liver disease. Consuming excess alcohol can further impair liver function. Stopping alcohol use may limit the progression of ascites.

Diuretics

Diuretic medications 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.

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 this is not successful, a liver transplant may be necessary.

Prevention

To help reduce the chance of ascites:

  • Drink alcohol only in moderation. This means no more than 1 drink per day for women and 2 per day for men.
  • Maintain a healthy weight.
  • Practice safe sex to avoid hepatitis.
  • Do not share IV needles.
  • Get vaccinated for hepatitis B.
  • If you were born between 1945 and 1965, you should get screened for hepatitis C infection.
  • If you are taking medications that can damage your liver, follow your doctor's instructions closely.
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
https://www.canada.ca

REFERENCES:

Ascites. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116330/Ascites. Updated July 31, 2017. Accessed March 14, 2018.

Ascites: A common problem in people with cirrhosis. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/ascites. Updated July 2013. Accessed March 14, 2018.

Bondini S, Younossi ZM. Non-alcoholic fatty liver disease and hepatitis C infection. Minerva Gastroenterol Dietol. 2006 Jun 52(2):135-143.

Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/liver-disease/cirrhosis/Pages/facts.aspx. Updated April 2014. Accessed March 14, 2018.

Hepatitis C: screening. US Preventive Services Task Force website. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-c-screening?ds=1&s=hepatitis%20C. Updated June 2013. Accessed March 14, 2018.

Last reviewed March 2018 by EBSCO Medical Review Board James P. Cornell, MD  Last Updated: 5/16/2014