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Ascites is the abnormal accumulation of fluid within the abdominal cavity. It is a condition with a wide range of causes. Ascites develops most frequently as a result of liver disease. It can also be seen in people who have cancer, kidney disease, pancreatic disease, heart disease, and other conditions.

What is going on in the body?

• The accumulation of fluid in the abdominal cavity can be associated with portal hypertension. This means there is an increased blood pressure in the veins draining the intestines and spleen toward the liver. The higher pressure can be caused by liver damage. It can also be caused by impaired drainage in the lymph system. This system takes excess fluid and particles away from the liver.
• Low levels of albumin and other proteins in the blood also contribute to ascites. The force that holds plasma water within the blood vessels is reduced. Plasma water is lost into the abdominal cavity. Albumin in the ascitic fluid pulls yet more fluid across into this cavity.
• Blood flow to the kidneys might be reduced. This leads to increased secretion of the hormone aldosterone. This increase causes the kidneys to retain salt and water. Urinary output is decreased, and fluid is retained. In some cases, kidney disease contributes to impaired elimination of salt and water.
• Fluid may leak from capillaries, the pancreas, or the lymph system. Capillary fluid leakage can be caused by inflammation or infection.

All of these events may lead to a large volume of abdominal ascites. An adult with cirrhosis of the liver may have as much as 10 to 12 liters (about 10-12 quarts) of fluid in the abdominal cavity.

What are the signs and symptoms of the condition?

• abdominal pain
• changes in bowel function
• difficulty breathing, especially when trying to take deep breaths
• difficulty walking
• fatigue
• feeling full after eating only small amounts of food
• increasing abdominal girth
• low back pain
• shortness of breath

What are the causes and risks of the condition?

• alcoholic liver disease
• chronic hepatitis from viruses, medications, or the person's immune system
• cirrhosis, which is permanent scarring of the liver
• liver cancer
• sudden liver failure, which can be due to infection or drug reactions

• bile leaking into the abdomen
• blood or fluid leaking from the blood vessels into the abdomen
• cancer
• certain kidney conditions
• congestive heart failure, a condition in which the weakened heart fails to pump blood effectively
• constrictive pericarditis, which is a tightening of the lining around the heart
• gastrointestinal diseases that cause a loss of protein, such as inflammatory bowel disease
• inflammation of the lining of the abdomen, known as peritonitis
• obstruction in the inferior vena cava, one of the largest veins in the body
• pancreatic fluid leaking into the abdomen
• severe malnutrition
• tuberculosis that has infected the peritoneum
• tumors on the lining of the abdomen

What can be done to prevent the condition?

Some cases of ascites can be prevented. For example, alcoholic cirrhosis can be prevented by avoiding excessive drinking of alcohol. Effective treatment of congestive heart failure can prevent ascites from that cause.

How is the condition diagnosed?

The diagnosis of ascites begins with a medical history and physical exam. The healthcare provider may be able to detect fluid in the abdomen. Special X-ray tests, such as an ultrasound or CT scan, are also commonly used to diagnose ascites and help determine the cause.

A diagnostic test, called paracentesis involves the insertion of a needle through the skin and into the abdominal cavity. The needle is used to withdraw fluid. Testing the fluid helps to determine the cause of the ascites. For example, an elevated white blood cell count, or WBC, may indicate an infection.

What are the long-term effects of the condition?

• difficulty breathing
• difficulty walking and performing daily activities
• gastrointestinal problems
• heart failure
• kidney failure
• infection of the ascites fluid
• malnutrition
• sleep disorders

What are the risks to others?

Ascites is not contagious and poses no risk to others.

What are the treatments for the condition?

• bed rest to improve kidney function
• a diet limited to 2 grams of sodium a day
• fluid restricted to 1 liter a day
• hospitalization to monitor the daily weight and salt balance

Diuretics, also called water pills, may also be used to treat ascites. These medications help the body excrete extra water through the kidneys. Common diuretics include spironolactone (i.e., Aldactone), amiloride (i.e., Midamor), and triamterene (i.e., Dtrebuyn(. If these are not effective, other diuretics may be used, including furosemide (i.e., Lasix), hydrocholorothiazide (HCTZ, i.e., Esidrix, HydroDiuril, Microzide, Oretic), and ethacrynic acid (i.e., Edecrin).

Some people with massive ascites may need a paracentesis to remove excess fluid. A needle is inserted into the abdominal cavity, and extra fluid is drained out.

Most people respond to these measures. About 10% to 15% are resistant and require other methods to control the ascites.

Other individuals may need a transjugular intrahepatic portosystemic shunt, also called TIPS. This is a mesh catheter tube that is passed through the skin of the neck and into the jugular vein. The catheter is then advanced into the liver. It is pushed into the portal vein, which drains into the liver. The shunt reduces pressure and ascites formation. In some cases, depending on the underlying cause, a liver transplant may be needed

.

What are the side effects of the treatments?

• dehydration
• high or low potassium levels in the blood
• kidney failure

• decreased kidney function
• low blood pressure, called hypotension
• shock

• abnormal blood clotting that may result in bleeding
• change in mental functioning or level of consciousness
• clotting of the shunt
• infection

What happens after treatment for the condition?

In most cases, treatment of ascites is lifelong.

How is the condition monitored?

Ascites is monitored with lab tests and regular visits to the healthcare provider. Any new or worsening symptoms should be reported to the provider.