Overview

Ascites refers to the abnormal accumulation of fluid within the peritoneal cavity, which is the space surrounding the abdominal organs. This condition leads to noticeable abdominal swelling and discomfort. Ascites is often a sign of an underlying medical issue, most commonly associated with liver disease, particularly cirrhosis. However, it can also result from cancer, heart failure, kidney disease, or infections. Managing ascites involves identifying and treating the underlying cause while relieving symptoms caused by fluid buildup.

Causes

Several medical conditions can lead to the development of ascites. Common causes include:

• Liver Cirrhosis: The most common cause, where scarring of liver tissue increases pressure in the portal vein (portal hypertension) and decreases protein production, leading to fluid leakage.
• Heart Failure: Poor heart function can cause fluid backup in the abdominal cavity.
• Cancer: Malignancies, especially cancers of the ovary, colon, stomach, pancreas, or liver, can cause malignant ascites.
• Kidney Disease: Conditions like nephrotic syndrome lead to low protein levels, contributing to fluid accumulation.
• Infections: Tuberculosis or spontaneous bacterial peritonitis (SBP) can cause ascites, especially in people with weakened immune systems.
• Pancreatitis: Inflammation of the pancreas can cause fluid leakage into the abdominal cavity.
• Hypoalbuminemia: Low levels of albumin in the blood, due to malnutrition or chronic illness, can result in ascites.

Symptoms

The presentation of ascites depends on the amount of fluid and the underlying cause. Common symptoms include:

• Progressive abdominal swelling or distention
• A sensation of heaviness or fullness in the abdomen
• Bloating and discomfort
• Shortness of breath due to pressure on the diaphragm
• Reduced appetite and early satiety (feeling full quickly)
• Weight gain due to fluid accumulation
• Swelling in the legs (peripheral edema)
• Nausea or digestive disturbances

Diagnosis

Diagnosing ascites involves clinical evaluation, imaging studies, and laboratory tests to determine the cause:

• Physical Examination: Doctors may detect shifting dullness or fluid wave upon abdominal examination.
• Ultrasound: The most common imaging technique to confirm the presence and amount of fluid.
• CT Scan: Provides detailed imaging to assess abdominal organs and potential malignancy.
• Paracentesis: A procedure where a needle is inserted into the abdomen to collect fluid for analysis. The fluid is tested for protein levels, albumin gradient (SAAG), cell count, and presence of infection or cancer cells.
• Blood Tests: Liver function tests, kidney function tests, albumin levels, and coagulation profiles help identify underlying conditions.

Treatment

The management of ascites depends on its severity and underlying cause:

• Sodium Restriction: Limiting salt intake helps reduce fluid accumulation.
• Diuretics: Medications like spironolactone and furosemide help promote fluid loss through urine.
• Paracentesis: For large-volume ascites, therapeutic paracentesis removes excess fluid to relieve discomfort.
• Intravenous Albumin: May be given during paracentesis to prevent circulatory dysfunction.
• Antibiotics: Used if infection is detected, especially in spontaneous bacterial peritonitis (SBP).
• TIPS Procedure (Transjugular Intrahepatic Portosystemic Shunt): In patients with refractory ascites, this procedure reduces portal hypertension by creating a channel within the liver.
• Treatment of Underlying Disease: Managing the primary condition such as liver disease, heart failure, or cancer is crucial.
• Liver Transplantation: Considered for patients with end-stage liver disease and recurrent ascites.

Prognosis

The prognosis for ascites varies depending on the cause and response to treatment. In cases of cirrhosis, the presence of ascites indicates advanced liver disease and is associated with a higher risk of complications and mortality. With proper medical management, symptom relief is possible, and quality of life can be improved. In malignant ascites, the prognosis depends on the type and stage of cancer. Early diagnosis, lifestyle changes, and appropriate treatment of the underlying disease play a key role in improving outcomes for individuals with ascites.