Living with Ascites: Signs, Causes, and How Doctors Treat It
Ascites is characterized by an abnormal buildup of fluid in the abdominal cavity. Unlike common bloating, ascites is a symptom of serious underlying circulatory disorders. Approximately 75% of the cases involve cirrhosis of the liver. Patients will often report the condition is " creeping " or " sneaking in " when, in fact, the volume of fluid can exceed ten liters. This buildup of fluid increases abdominal pressure, which can cause discomfort, nausea, shortness of breath, and even fainting. Where abrupt symptom management is called for, the underlying disease must also be addressed.
What Are the Causes of Ascites?
Fluid doesn’t just accumulate in the abdomen for no reason. The most common include:
1. Portal Hypertension
Fluid is pushed out of the portal vein, the large vein that carries blood from the intestines to the liver, into the abdomen. This is common with liver cirrhosis, cancer, heart failure, and portal vein thrombosis.
2. Cancer
Malignant tumors and metastases can block, and the tumor can "sweat" tumor fluid directly into the abdomen. Cancer cells also produce proteins that encourage neovascularization and leaky blood vessels. This allows even more fluid to seep into the abdomen.
3. Inflammation
Conditions like peritonitis and pancreatitis cause hyperemia and increase vasculature permeability. This allows fluid and some immune cells to leave the blood and enter the abdominal cavity.
Fluid build-up will cause abdominal swelling. Patients can have a zaiya (stretched) or flattened navel and, in severe cases, an umbilical hernia. The fluid will also push the diaphragm up and cause breathing difficulties.
How Is Ascites Treated?
Ascites is best managed by addressing the underlying condition causing the fluid build-up; this may include stopping the liver from further damaging, removing a tumor, or treating in infection. The condition causing the ascites, however, takes time, and as such, the physician works on minimizing the discomfort from the fluid build-up.
Lifestyle & Basic Measures
The important self-care measures are:
- Limit fluid intake to about 1.5 liters a day.
- Reduce salt intake to less than 5 grams per day.
- Daily weigh-ins help track fluid retention.
- Diuretics (Water Pills)
Diuretics, particularly spironolactone, with or without furosemide, are used to help the kidneys get rid of excess fluid. The physician needs to monitor the status of the kidneys and electrolytes, as these medications may result in kidney damage.
- Paracentesis (Fluid Drainage)
In patients with ascites not responding to diuretics, the physician may use a fine needle to withdraw between 0.5 to 1.5 liters of fluid. This is a palliative intervention done to provide rapid relief.
- Permanent Drainage Systems
In patients with chronic ascites, a small catheter can be placed through the abdominal wall, allowing the patient to perform drain maintenance, to minimize fluid build-up and manage symptoms.
Diagnosis & Next Steps
While ascites is usually diagnosed using abdominal ultrasounds, determining the cause takes more detective work. Physicians often sample the ascitic fluid (paracentesis) and check for proteins, inflammation, infection, and malignant cells. Subsequently, blood work and other imaging assess if cirrhosis, cancer, or heart disease is the underlying cause.
The Bottom Line
Ascites is not an isolated condition, and whether inflammation, cancer, or liver failure is the underlying cause, it indicates serious illness. The positive aspect is that many patients achieve a good quality of life after a definitive diagnosis, control of the fluid, and treatment of the underlying condition.