What is Ascites?


Fluid in our bodies is a good thing … except when that fluid is in the wrong place. Ascites is a condition in which fluid collects in the space around the internal organs. This area is called the peritoneal cavity. Typically the cavity surrounding the organs does contain a small amount of fluid and can fluctuate slightly in women based on their menstrual cycles. However, when too much fluid collects here, it is a sign of something more serious and leads to medical complications. The symptoms of ascites include things like bloating, abdominal pain, weight gain, and shortness of breath. However, ascites itself is technically a symptom of more serious diseases which causes the fluid to accumulate. Ascites cannot be prevented, but you can lower your risk by addressing the underlying cause.

What is the Cause of Ascites?


There are numerous underlying diseases that can cause ascites. The most common is liver disease, or more specifically cirrhosis of the liver. The liver is a large organ that is central to the process of digestion, excreting a fluid called bile which helps to break down fat. The liver also serves as a filter, removing toxins and helping to manage cholesterol, sugars, and hormones. Cirrhosis is when damaged liver tissue is replaced by scar tissue. The scar tissue limits the functionality of the liver, and can eventually lead to liver failure. Alcohol consumption is the main cause of liver cirrhosis, but there are other causes of liver disease, such as viral hepatitis infections (B and C), as well as nonalcoholic fatty liver disease (NAFLD). Whatever the reason for liver failure, the result is that the liver can no longer produce enough protein to maintain oncotic pressure. This is pressure that keeps fluid in the circulatory system from escaping. So when oncotic pressure decreases, fluid can leak out, including into the peritoneal cavity.

Other causes of ascites also involve the liver. Ascites can be caused by cancer that spreads to the liver. Or by Budd-Chiari Syndrome—a disease where the veins that drain the liver become blocked. Both of these can result in fluid build-up in the peritoneal cavity—or ascites.

Heart failure is another cause of ascites. When the heart cannot adequately pump blood through the vessels, fluid can back up into the body’s organs, including the lungs. When this happens, the organs fail and fluid can leak into the peritoneal cavity. Ascites can also be a result of issues with the kidney. Nephrotic Syndrome is when a damaged kidney leaks protein into the urine, which similarly decreases oncotic pressure, causing fluid to build up.

Another organ that can be involved in ascites is the pancreas. The pancreas is a glandular organ that contributes to both the digestive system and the endocrine or hormone system. Inflammation of the pancreas (called pancreatitis), as well as pancreatic cancer, can cause ascites. The development of ascites is often one of the first noticeable symptoms of ovarian cancer. Cancer of the ovaries, as well as benign tumors of the ovary, can cause ascites.

Hypothyroidism and tuberculosis can also increase your risk of developing ascites.

Because there are so many different possible underlying causes for ascites, it is crucial to consult your doctor who can help you identify and treat the source of the condition.

What are the Symptoms of Ascites?


Small amounts of fluid in the abdominal cavity may not cause any discomfort or health complications. However, as the fluid builds, symptoms like bloating, abdominal pain, shortness of breath, weight gain or loss, and fatigue increase. Along with these symptoms you may experience swelling in the legs and feet, a visibly distended abdomen, a sense of fullness or heaviness, indigestion, nausea or vomiting, and loss of appetite.

The symptoms of ascites can vary based on the underlying disease, making it crucial that you talk with your doctor about all your symptoms and receive an accurate diagnosis. While ascites caused by liver failure is typically painless, ascites caused by cancers present with significant abdominal pain. 

Symptoms of ascites can come on suddenly or develop slowly over time. Because the symptoms are the same as numerous other conditions and diseases, you should talk with your doctor about all your symptoms. The symptoms could be due to a passing illness but can indicate serious health issues that need medical attention. Unaddressed ascites can lead to other complications including a type of kidney failure called hepatorenal syndrome, pleural effusion (also called water on the lung), hernias, and a bacterial infection called spontaneous bacterial peritonitis (SBP).

How is Ascites Diagnosed and Treated?


Treatment for ascites is based on the underlying cause. Your doctor will assess your symptoms and do a physical examination of your abdominal area, looking for swelling and asking about pain. They will also likely run blood tests to look for indicators of infection, inflammation, or levels of proteins. Imaging tests like the ones listed below can detect fluid as well as show the condition of internal organs, and may also be helpful in diagnosis.

  • Ultrasounds are painless and use high-frequency sound waves to capture real-time images and video. Ultrasounds can show size, structure, and movement of organs, as well as the flow of blood through blood vessels.
  • Magnetic resonance imaging (MRI) uses magnets and radio waves to create images of the inside of your body. An MRI can create cross-sectional views, allowing your doctor to see the condition of soft tissue and organs without making any incisions.
  • Computed Topography Scan (CT Scan) is a specialized x-ray that circles your body and creates multiple images. A doctor can then see your organs, blood vessels, and bones from various perspectives.

Once your doctor has gathered the necessary information, a diagnosis can be made. From there a treatment plan can be made to address both the underlying cause and the ascites. 

Diuretics are drugs that are commonly prescribed in the treatment of ascites. Diuretics work to lower the pressure in the veins that surround the liver. They do this by increasing the amount of salt and water that leaves your body. If the ascites is severe, your doctor may recommend a procedure called paracentesis. Paracentesis involves inserting a long thin needle through the skin of the abdomen and into the peritoneal cavity in order to remove excess fluid.

If the ascites is extreme or doesn’t respond to other treatments, surgery may be necessary. A tube called a shunt can be permanently implanted in order to reroute the flow of blood around the liver. A liver transplant surgery may be necessary if ascites is being caused by end-stage liver disease.

Can Ascites be Prevented?


The presence of fluid in the peritoneal cavity is caused by other underlying health issues, so it cannot be specifically prevented. However, you can decrease your risk of ascites by taking steps to prevent the underlying causes. The most important step you can take is to protect your live by consuming less alcohol. You can also protect yourself and your liver by protecting against Hepatitis through vaccinations, using condoms during sex, and never sharing needles with other drug users.

Maintaining a healthy diet, getting regular exercise, and getting adequate sleep are all powerful tools in maintaining overall health. In addition, consult with your doctor about scheduled testing and screenings, as well as regular monitoring of the medications you take on a continuing basis. At Carolina Digestive Health Associates, we have the doctors and resources to help you address any gastrointestinal concerns you may have, including symptoms of ascites or an underlying cause. Our fourteen board-certified gastroenterologists are ready to serve you at eight locations and five endoscopy centers throughout the Charlotte metropolitan area, as well as all local area hospitals. Book an appointment today.