Ascites

What is ascites?

Ascites is the accumulation of fluid in the space between the lining of the abdomen and the abdominal organs, known as the peritoneum. Ascites is usually a symptom of another illness or condition and is most commonly associated with liver disease, liver cirrhosis and types of cancer.

Prognosis

Ascites can respond well to treatment, however, usually it is the underlying cause of the ascites that is more concerning and requires treatment. In any case, if ascites is suspected, it is necessary to see a specialist so that they can make a diagnosis and proceed to the best treatment for each case.

Symptoms of ascites

The main symptom of ascites is abdominal distension, which patients may notice when clothing becomes tighter, or their belt size increases. In cases where the ascites are advanced, the patient may describe a feeling of heaviness in their abdomen. If the patient also gains weight, they may experience issues with mobility.

Other symptoms of ascites may include:

  • Constipation
  • Loss of appetite
  • Indigestion
  • Nausea and vomiting
  • Shortness of breath

Symptoms of other illnesses, such as liver failure may also be present, as can the symptoms of other conditions that cause ascites. In cases where the pathology is more serious, symptoms such as peritonitis, weight loss, and malnutrition, mental confusion, bleeding in the upper or lower intestines may be present.

Medical tests for ascites

The specialist will first perform a physical exam to determine the extent of swelling in the abdomen. Other tests may also be used to assess the condition of the liver and kidneys. Among them are:

  • Assess electrolyte levels
  • Kidney function tests
  • Liver function tests
  • Tests to measure the risk of bleeding and protein levels in the blood
  • Urine analysis
  • Abdominal ultrasound

The specialist may also consider it appropriate to remove a small amount of the fluid produced by the ascites to analyse it.

What are the causes of ascites?

Ascites is caused by high pressure in the liver's blood vessels, also known as portal hypertension, and low levels of the protein called albumin. Diseases that cause severe liver damage can also lead to the development of ascites. These would include prolonged infection with hepatitis C or B, excessive alcohol consumption over a long period and fatty liver.

Other risk factors for contracting ascites would be some types of cancer in the abdomen, such as cancer of the appendix, colon, ovary, uterus, pancreas and liver. Furthermore, conditions such as clots in the liver veins or thrombosis of the portal vein or congestive heart failure can also cause ascites.

Can it be prevented?

Prevention of ascites involves trying to avoid some of its risk factors such as reducing or stopping alcohol consumption and decreasing salt intake.

Treatments for ascites

To treat ascites, the specialist will proceed to treat the underlying cause. First, he will recommend a change in lifestyle, avoiding alcohol, reducing salt intake and reducing fluid intake. Some medications such as diuretics may also be used to remove excess fluid and antibiotics for infections.

In some cases, where the above methods have not worked, a procedure called paracentesis will be offered, which uses a needle inserted into the abdomen to remove large amounts of fluid. This procedure is also known as an ascitic drain.

Patients suffering from terminal liver disease may require a liver transplant.

Which specialist treats ascites?

The specialist who will diagnose and subsequently treat a patient with ascites would usually be a hepatologist.

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