Ascites Latest Facts: Causes, Symptoms, Treatment and Prevention

Ascites is an accumulation of fluid in the abdomen. It is usually caused by a problem with the digestive system especially cirrhosis or alcoholic hepatitis. Although it is not a life-threatening condition, it can be a sign of severe liver damage.

Ascites. Image Courtesy of James Heilman, MD

What is ascites?

Ascites is a fluid deposit (or accumulation of fluid) in the abdominal cavity. In colloquial language, it is sometimes called “water in the belly.” The term ascites is also used to describe this fluid that accumulates in the abdomen.

Usually, very small amounts of fluid are present in the peritoneal cavity, but its accumulation leads to symptoms and possible complications. Ascites is not a life-threatening condition, but it can be a sign of severe liver damage.
Depending on the cause of ascites, symptoms may occur suddenly or develop slowly. It is also possible, that ascites causes no symptoms if the amount of fluid retained is low.

The accumulation of fluid is usually accompanied by swelling of the abdomen and rapid weight gain, abdominal pain, and bloating. Large amounts of fluid may also cause shortness of breath.

Other symptoms often associated with shortness of breath are as follow:

Nausea and vomiting
Swelling of the legs and ankles
Indigestion
Heartburn
Loss of appetite

If the amount of fluid in the abdomen is significant, a clinical examination is sufficient for diagnosis. If the effusion is limited, an ultrasound may be required. Further examination with a CT scan (computed tomography) of the abdominal cavity may also help determine the cause of ascites. And an ascites puncture may be needed to analyze the fluid to determine the source of the effusion and detect possible infection.

Causes of ascites

Three situations can lead to the development of ascites:

The rupture, within the peritoneum, of a fluid channel.
Abnormal reabsorption of normally present peritoneal fluid.
An overproduction of peritoneal fluid.

Several diseases can cause these situations:

alcoholic cirrhosis. In this case, symptoms may occur suddenly with a significant accumulation of fluid. This is called Ascitic oedematous decompensation.
Alcoholic hepatitis.
Diseases that can cause severe liver damage, such as chronic infections like hepatitis C or B.
Cancers of the digestive system, such as cancers of the colon, pancreas, and liver, as well as cancers of the ovaries and uterus and peritoneal carcinomas (metastatic tumors that invade the peritoneum).
In rarer cases, peritoneal tuberculosis and chronic pancreatitis can cause ascites.

Possible course and complications

Ascites in itself is not life-threatening and the main risk of fluid accumulation in the abdomen is an infection of the fluid. In this case, it becomes a medical emergency that must be treated quickly with antibiotics. Fluid accumulation can also cause breathing problems due to pressure on the diaphragm or pleural effusion. Ascites can also lead to abdominal and umbilical hernias.

Treatment and prevention: what are the solutions?

The first step is to treat, if possible, the disease that is causing the ascites.

Ascites prevents the elimination of salts through the urine. Therefore, the first step in treatment is to reduce the intake of salt in the diet through a salt-free diet. The doctor may also prescribe diuretics to help drain fluids.
If the ascites is profuse and persists despite medical treatment (salt-free diet and diuretics); an ascites puncture may be performed to relieve the patient by decompression of the abdomen.