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Ascites

Definition

Ascites is the accumulation of excess fluid in the abdominal cavity. This condition can be treated, so if you think you have ascites, contact your doctor.

Ascites

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© 2008 Nucleus Medical Art, Inc.

Causes

Ascites is usually caused by liver disorders, including:

  • Cirrhosis—a disease in which the liver becomes permanently damaged
  • Chronic hepatitis—an infection of the liver
  • Severe alcoholic hepatitis without cirrhosis
  • Obstruction of the hepatic vein (a blood vessel of the liver)

It can also be caused by:

Risk Factors

A risk factor is something that increases your chance for getting a disease or condition. The following factors increase your chance of having ascites. If you have any of these risk factors, tell your doctor:

  • Alcoholism
  • Hepatitis B or C

Symptoms

If you experience any of these symptoms do not assume it is due to ascites. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

  • Increased abdominal circumference
  • Shortness of breath
  • Abdominal pain and/or distention
  • Pain in the side abdomen
  • Rapid weight gain
  • Difficulty breathing while lying flat
  • Decreased appetite
  • Heartburn

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:

  • Ultrasound—a test that uses sound waves to examine the abdominal cavity
  • Computed tomography (CT) scan—a type of x-ray that uses a computer to make pictures of structures inside the abdominal cavity
  • Magnetic resonance imaging (MRI)—a test that uses magnetic waves to make pictures of structures inside the abdominal cavity
  • Laparoscopy—a thin, lighted tube inserted through a small incision in the abdomen to look at the structures inside the abdominal cavity
  • Blood tests—to determine liver and kidney function as well as evidence of other problems that may lead to ascites
  • Liver biopsy—removal of a sample of liver tissue for testing
  • Angiography—x-rays taken after a dye is injected into the arteries to better view the area being examined
  • Diagnostic paracentesis –removal and testing of fluid from the abdominal cavity

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Sodium Restriction

Limiting salt intake to 2,000 mg per day or less is often recommended to reduce or delay fluid build-up. More extreme restrictions in salt intake do not further improve outcomes.

Diuretics (Water Pills)

Diuretic medications (drugs that cause the kidneys to excrete more sodium and water in the urine) are often recommended as the treatment of choice (along with sodium restriction) for ascites. Among diuretics, spironolactone (Aldactone) or furosemide (Lasix) may be given; or a combination of both may be prescribed if one alone does not work.

Paracentesis

Ascites can be treated by inserting a hollow needle into the abdomen and removing excess fluid through the needle.

Stop Alcohol Use

Ascites commonly occurs in people who have liver disease. Consuming alcohol can further impair liver function. Stopping alcohol use may limit the progression of ascites.

Surgery

Some patients have ascites that does not get better or keeps coming back despite the treatments noted above. A surgical procedure that that diverts blood flow away from the liver may help.

Prevention

To decrease the risk of ascites, take the following steps to prevent cirrhosis, the most common cause of ascites:

  • Drink alcohol in moderation (no more than one drink per day for women and two for men).
  • Practice safe sex to avoid hepatitis.
  • Do not share intravenous (IV) needles.
  • Get vaccinated for hepatitis B.
  • Take blood tests as recommended by your doctor when taking medications that may damage your liver.

If you have had ascites, you can prevent their reoccurrence by doing the following:

  • Avoid alcohol consumption.
  • Limit use of all medications including over-the-counter drugs (eg, nonsteroidal anti-inflammatory drugs (NSAIDs)), unless recommended otherwise by your doctor.
  • Restrict sodium intake.
  • Take diuretics as recommended by your doctor.

RESOURCES:

American Liver Foundation
http://www.liverfoundation.org

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References:

Ascites. DynaMed website. Available at: http://dynamed102.epnet.com/Detail.aspx?id=116330 . Accessed February 7, 2008.

Ascites. Merck website. Available at: http://www.merck.com/mmhe/sec10/ch135/ch135e.html . Accessed December 1, 2006.

Cesario K, Carey WD. Ascites. Cleveland Clinic website. Available at: http://www.clevelandclinicmeded.com/diseasemanagement/gastro/ascites/ascites.htm . Accessed December 3, 2006.



Last reviewed February 2008 by Richard Glickman-Simon, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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