What is ascites?

Written by: Dr Deepak Joshi
Edited by: Cal Murphy

We all experience abdominal discomfort from time to time. We might feel bloated; we might put on a little weight. However, sometimes, when these symptoms all come together, perhaps with shortness of breath, it can be an indication that our bodies are experiencing a build-up of fluid. Leading hepatologist Dr Deepak Joshi is here to explain ascites and how it can affect you.

What is ascities?

Ascites is the accumulation of fluid in the abdomen (peritoneal cavity). One of the most common causes is chronic liver disease (cirrhosis) and the development of portal hypertension (high pressure in the portal vein). Other causes of ascites include heart failure, nephrotic syndrome (protein loss from the kidneys) and pancreatitis.


What are the main symptoms?

If the ascites is mild then you are unlikely to have any symptoms. It can only be seen using an ultrasound scan. As the ascites accumulates, then there will be progressive abdominal distension. This can lead to pressure in the abdomen and also shortness of breath due to the lung cavity and diaphragm (main muscle of respiration) being compressed.


Does being diagnosed with ascites mean your liver condition is worsening?

Yes. The development of ascites is suggestive of progressive portal hypertension. The ascites can become infected spontaneously. If you have ascites and develop a fever and abdominal pain, then the ascites needs to be checked for infection. You should seek urgent medical advice if you develop these symptoms.


How can ascites be treated? Is drainage required?

The first step involves a low salt/no added salt diet. This helps the body to excrete the fluid in urine. Other ascites treatment options include the use of water tablets (diuretics) such as spironolactone and furosemide. These diuretics can affect the kidneys and so monitoring of kidney function is required. If the ascites is tense then a drain is required. If the ascites becomes refractory to diuretics and regular drains are required then other treatment options include radiological procedures called a TIPS (transjugular intrahepatic porto-systemic) shunt or a liver transplant.


If you are concerned that you may have ascites, visit Dr Joshi’s Top Doctors profile to book an appointment today.

By Dr Deepak Joshi
Hepatology (liver specialist)

Dr Deepak Joshi is a leading consultant hepatologist practising at private clinics in London. Dr Joshi specialises in liver disease, liver transplant, pancreatic diseases, bile duct diseases, and cirrhosis amongst others. At present, Dr Joshi is practising at the Guthrie Clinic, a part of King's College Hospital, the Institute of Liver Studies, and the London Liver Centre.

After qualifying in medicine from King's College in 2001, he went on to train in hepatology at the Institute of Liver Studies for five years, where he carried out a PhD researching into predictors of fibrosis in patients following a liver transplant. He further honed his skills in adult and paediatric endoscopy and ERCP whilst training at the reputable University College London Hospitals.

An active researcher in the hepatology field, he has published extensively in peer-reviewed papers, contributed to book chapters, and co-authored "Hepatology at a Glance". His main clinical interests include biliary disease, as well as treatment and management of all kinds of conditions to do with the liver or pancreas.

Dr Joshi educates future hepatologists as a clinical lecturer at King's College London outside of his practising and research hours. In addition, he sits on the expert panel of the PSC Support, a leading charity for primary sclerosing cholangitis. Additionally, he is a Liver Committee member for the British Society of Gastroenterology, which he has been a participant of since 2016.

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