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What Is Ascites?

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Updated July 08, 2014

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Ascites (pronounced a-sight-eez) is extra fluid in the space between the tissues lining the abdomen and the organs in the abdominal cavity (such as the liver, spleen, stomach). This space between the tissues is called the peritoneal cavity. One layer of tissue lines the inside of the belly wall and the other layer of tissue lines the outside of the organs. These two layers are actually one continuous layer that sort of wraps around or doubles back on itself, but the important idea is that there is space between these layers which is normally filled with a small amount of fluid (called peritoneal fluid) that helps lubricate the organs as they move around inside your belly. Sometimes, diseases can cause an excess of fluid to accumulate in the peritoneal cavity. This extra fluid causes the condition of ascites.

How Does Liver Disease Cause Ascites?

Ascites is caused by many diseases, including liver disease, congestive heart failure, nephritis, infection and cancer, to name some of the most common. One of the complications of cirrhosis, a disease caused by chronic hepatitis, is portal hypertension which is an increase of pressure in the portal vein system. One of the functions of the liver is to remove certain kinds of wastes from the body's blood supply which can pass through your liver every five minutes. The liver is supplied by blood from the heart through the hepatic artery and by blood from the gut (the digestive system) and pancreas through the portal vein. When cirrhosis develops, the portal vein system cannot filter effectively through the cirrhotic and nodular liver which results in increased pressure of the blood flowing from the digestive system. This increased pressure forces fluid (made up of water and proteins) out of the blood vessels which collects in the abdominal cavity.

Why the Liver Is So Important

The complete cause of ascites is complex and involves several systems. One of those systems is the kidneys, which play a large role by conserving water. As fluid leaks from the liver, the blood volume is reduced. In order to compensate, the kidneys begin to retain sodium which conserves water and maintains the normal level of blood.

Though the most common cause of ascites is cirrhosis, other reasons need to be considered. One way the doctor can do this is by removing a sample of fluid using a needle and sending it to a lab for testing. Technicians can tell a lot of pathology just by looking at the appearance of the fluid. For example, "cloudy" suggests an infection while "bloody" can suggest a tumor or a traumatic tap (which is inside bleeding at the site of a needle puncture).

What Are Causes of Cirrhosis?

Why Is Ascites a Problem?

Ascites usually leads to respiratory problems (such as shortness of breath), malnutrition and extreme fatigue.

Diagnosis: How Doctors Find Ascites

Someone with ascites may have an increase in girth around the belly and this may be enough to determine ascites. It's possible for 20 liters of fluid (think of 10, 2 liter bottles of soda!) to collect in the abdominal cavity, and only one-half liter is necessary to be clinically detectable. Doctors who suspect ascites will look for bulging areas in the abdomen that sound consistently dull when tapped by the fingers. An ultrasound helps clarify the results of physical examination of people with mild or subtle ascites.

Treatment: How You Can Manage Your Ascities

Ascites caused by liver disease is impossible to cure because it would require removing the underlying cirrhosis. However, mild ascites can be effectively managed by restricting sodium in the diet to less than 2 grams each day. Achieving this target amount is relatively difficult because it usually requires a significant change in eating habits, such as avoiding most processed foods and most restaurant-prepared foods.

Nutrition for Chronic Hepatitis

A Diet for Cirrhosis

For moderate and severe ascites, your doctor will probably prescribe a diuretic medication which causes you to increase your urination. If your ascites isn't controlled by diet or medication, your doctor might choose a procedure called paracentesis (which uses a needle to collect fluid) or use a shunt (TIPS, transjugular intrahepatic portosystemic shunt) to help drain the fluid.

Sources:

Bacon BR. Cirrhosis and Its Complications. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008. 1978-1979.

Glickman RM, Rajapaksa R. Abdominal Swelling and Ascites. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008. 266-268.

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  5. Ascites and Cirrhosis From Chronic Hepatitis

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