What is ascites and how does it affect the body. What are the primary causes of ascites and who is at risk. How is ascites diagnosed and what treatment options are available. Can ascites be prevented through lifestyle changes.

What is Ascites and How Does it Affect the Body?

Ascites is a medical condition characterized by the accumulation of fluid in the abdominal cavity. This buildup can lead to a range of uncomfortable symptoms and potentially serious complications. But how exactly does ascites affect the body?

The excess fluid in the abdomen can cause:

• Abdominal swelling and distension
• Discomfort and pain
• Difficulty moving and breathing
• Increased risk of abdominal infections
• Potential complications in other organs, such as the lungs and kidneys

The severity of ascites can vary, with some patients experiencing mild symptoms while others face significant discomfort and health risks. Understanding the underlying causes and seeking prompt medical attention is crucial for managing this condition effectively.

Primary Causes of Ascites: From Liver Disease to Cancer

While ascites can stem from various medical conditions, certain factors are more commonly associated with its development. What are the primary culprits behind this fluid accumulation?

Cirrhosis of the Liver

The most frequent cause of ascites is cirrhosis, a condition characterized by scarring and dysfunction of the liver. Cirrhosis can result from:

• Chronic alcohol abuse
• Viral hepatitis (B and C)
• Nonalcoholic fatty liver disease
• Autoimmune liver diseases

Cancer

Various types of cancer can lead to ascites, particularly in advanced or recurrent stages. Some cancers associated with ascites include:

• Ovarian cancer
• Pancreatic cancer
• Liver cancer
• Colon cancer

Other Potential Causes

While less common, ascites may also develop due to:

• Heart failure
• Kidney disease, especially in patients undergoing dialysis
• Low protein levels in the blood (hypoproteinemia)
• Infections within the abdominal cavity

Recognizing the Symptoms: When to Seek Medical Attention

Identifying the signs of ascites early can lead to more effective management and treatment. What symptoms should you be on the lookout for?

Common indicators of ascites include:

• Noticeable swelling or distension of the abdomen
• Unexplained weight gain
• A feeling of fullness or heaviness in the abdomen
• Nausea, indigestion, or loss of appetite
• Shortness of breath, especially when lying down
• Swelling in the lower legs (edema)
• Development or worsening of hemorrhoids

Is sudden abdominal swelling always indicative of ascites? While ascites is a common cause of abdominal distension, other conditions such as bloating, pregnancy, or abdominal tumors can present similarly. Therefore, it’s crucial to consult a healthcare provider for an accurate diagnosis if you experience persistent or concerning symptoms.

Diagnostic Approaches: Uncovering the Underlying Cause

Accurate diagnosis of ascites involves a combination of physical examination and diagnostic tests. How do healthcare providers confirm the presence of ascites and determine its cause?

Physical Examination

A thorough physical exam may reveal:

• Visible abdominal distension
• Fluid wave or shifting dullness when tapping the abdomen
• Signs of underlying liver disease, such as jaundice or spider angiomas

Diagnostic Imaging

Various imaging techniques can help visualize and quantify the fluid accumulation:

• Abdominal ultrasound
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)

Paracentesis

This procedure involves extracting a sample of the ascitic fluid using a needle. Analysis of this fluid can provide valuable information about:

• The underlying cause of ascites
• Presence of infection or malignant cells
• Protein content and other biochemical markers

How does paracentesis differ from therapeutic fluid removal? While diagnostic paracentesis involves removing a small amount of fluid for analysis, therapeutic paracentesis aims to drain larger volumes to relieve symptoms and improve comfort.

Treatment Strategies: Managing Ascites and Its Underlying Causes

The management of ascites often requires a multifaceted approach, addressing both the fluid accumulation and the underlying condition. What are the primary treatment strategies employed by healthcare providers?

Dietary Modifications

Dietary changes play a crucial role in managing ascites, particularly:

• Sodium restriction: Limiting salt intake to 2,000 mg per day or less
• Fluid restriction: In some cases, limiting daily fluid intake
• Avoiding alcohol: Particularly important for patients with liver disease

Medications

Several types of medications may be prescribed:

• Diuretics: To promote fluid excretion through increased urination
• Aldosterone antagonists: To block hormones that contribute to fluid retention
• Antibiotics: In cases of spontaneous bacterial peritonitis

Procedures

In more severe or refractory cases, procedures may be necessary:

• Large-volume paracentesis: Removal of significant amounts of ascitic fluid
• Transjugular intrahepatic portosystemic shunt (TIPS): Creating a bypass to reduce portal hypertension in liver disease
• Liver transplantation: For end-stage liver disease

How effective are these treatments in managing ascites? While treatment effectiveness can vary depending on the underlying cause and individual factors, many patients experience significant symptom relief and improved quality of life with appropriate management.

Preventing Ascites: Lifestyle Changes and Risk Reduction

While not all cases of ascites can be prevented, certain lifestyle modifications can significantly reduce the risk of developing this condition. What steps can individuals take to lower their chances of experiencing ascites?

Liver Health

Maintaining liver health is crucial in preventing ascites, particularly:

• Abstaining from alcohol or drinking in moderation
• Getting vaccinated against hepatitis B
• Practicing safe sex and avoiding intravenous drug use to prevent hepatitis C
• Managing weight and controlling diabetes to prevent nonalcoholic fatty liver disease

General Health Practices

Other lifestyle factors that can contribute to overall health and potentially reduce ascites risk include:

• Maintaining a healthy weight through diet and regular exercise
• Quitting smoking
• Limiting salt intake
• Managing underlying health conditions, such as heart disease or kidney problems

Is it possible to completely eliminate the risk of ascites? While these preventive measures can significantly reduce the risk, some factors contributing to ascites, such as certain cancers or genetic predispositions, may not be fully preventable. Regular health check-ups and early intervention for any underlying conditions remain crucial.

Living with Ascites: Coping Strategies and Quality of Life

For individuals diagnosed with ascites, learning to manage the condition effectively is key to maintaining a good quality of life. What strategies can help patients cope with the challenges of living with ascites?

Daily Management

Incorporating these practices into daily life can help manage ascites:

• Adhering to prescribed dietary restrictions, particularly sodium limitation
• Monitoring daily weight to track fluid accumulation
• Taking medications as directed by healthcare providers
• Staying physically active within individual limitations

Emotional and Social Support

Living with a chronic condition like ascites can be emotionally challenging. Support can come from:

• Joining support groups for patients with liver disease or ascites
• Seeking counseling or therapy to address emotional challenges
• Educating family and friends about the condition to foster understanding and support

Regular Medical Follow-up

Maintaining open communication with healthcare providers is crucial:

• Attending scheduled follow-up appointments
• Reporting any new or worsening symptoms promptly
• Discussing any challenges with treatment adherence or side effects

How can patients balance managing their condition with maintaining a normal lifestyle? While ascites may require some lifestyle adjustments, many patients find that with proper management and support, they can continue to engage in many of their regular activities and maintain a fulfilling life.

Understanding ascites, its causes, and management strategies is crucial for both patients and their caregivers. By working closely with healthcare providers and adopting appropriate lifestyle modifications, individuals with ascites can often achieve significant symptom relief and improved quality of life. As research in this field continues, new treatment options and management approaches may offer even better outcomes for those affected by this challenging condition.

Ascites | Johns Hopkins Medicine

Ascites | Johns Hopkins Medicine

What is ascites?

Ascites is a condition in which fluid collects in spaces within your abdomen. If severe, ascites may be painful. The problem may keep you from moving around comfortably. Ascites can set the stage for an infection in your abdomen. Fluid may also move into your chest and surround your lungs. This makes it hard to breathe.

What causes ascites?

The most common cause of ascites is cirrhosis of the liver. Drinking too much alcohol is one of the most common causes of cirrhosis of the liver.  

Different types of cancer can also cause this condition.  Ascites caused by cancer most often occur with advanced or recurrent cancer. Ascites may also be caused by other problems such as heart conditions, dialysis, low protein levels, and infection.

What are the symptoms of ascites?

These are symptoms of ascites:

• Swelling in the abdomen
• Weight gain
• Sense of fullness
• Bloating
• Sense of heaviness
• Nausea or indigestion
• Vomiting
• Swelling in the lower legs
• Shortness of breath
• Hemorrhoids

How is ascites diagnosed?

Your healthcare provider will do a physical exam and ask about your symptoms. You may also have tests such as:

• Fluid sample. A sample of fluid from your abdomen may be taken using a needle. This fluid will be checked for signs of disease, such as cancer or an infection. This test may help point to the cause of the ascites.
• Imaging. Your healthcare provider may request images of the inside of your abdomen using ultrasound, MRI, or a CT scan. An MRI creates images using a magnetic field and radiofrequency energy. A CT scan creates computerized images using X-rays.

How is ascites treated?

A number of steps may help ease your ascites. Your healthcare provider may tell you to:

• Cut back on your salt intake. Your healthcare provider or a dietitian can show you how to follow a low-sodium diet. Avoid salt substitutes that contain potassium. This is because some medicines used in treating ascites can cause your potassium levels to rise.
• Cut back on the amount of fluids you drink.
• Stop drinking alcohol.
• Take diuretic medicines to help reduce the fluid in your body.
• In certain cases, your doctor may need to remove large amounts of fluid from your abdomen through a needle. This may be done if you have trouble breathing or the diuretic is not working.
• In very complicated situations, you may need to have a special procedure in radiology called TIPS. In this procedure, a connection is made inside the liver between the blood vessels to ease the high pressure causing ascites.

What are the complications of ascites?

Ascites can make eating, drinking, and moving around difficult. It can also make it hard to breathe. Ascites can lead to abdominal infections, which may cause kidney failure. It can also cause umbilical or inguinal hernias.

Can ascites be prevented?

Certain steps to help you avoid cirrhosis of the liver and cancer can prevent ascites. These include:

• Stop drinking alcohol.
• Maintain a healthy weight.
• Exercise regularly.
• Stop smoking.
• Limit salt in your diet.
• Practice safe sex to decrease your chance of getting hepatitis.
• Do not use recreational drugs to decrease your chance of getting hepatitis.

Living with ascites

Be sure to follow your healthcare provider’s advice for lowering your salt intake. You’ll need to do this even if you’re taking diuretic drugs to reduce fluid in your body. Also, weigh yourself daily and call your healthcare provider if you gain too much weight.

Key points

• Ascites is a condition in which fluid collects in spaces within your abdomen.
• As fluid collects in the abdomen, it can affect your lungs, kidneys, and other organs.
• Ascites causes abdominal pain, swelling, nausea, vomiting, and other difficulties.
• Stopping all alcohol intake, maintaining a healthy weight, exercising, not smoking, and limiting salt intake can help prevent cirrhosis or cancer that may lead to ascites.
• Ascites can’t be cured but lifestyle changes and treatments may decrease complications.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

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What is ascites (fluid in the abdomen)? | Coping physically

The medical name for a build up of fluid in the abdomen is ascites (pronounced ay-site-eez). It can also be called malignant ascites.

The tummy (abdomen) contains many organs, including the stomach, bowels, pancreas, liver, spleen and kidneys. There is a sheet of tissue (peritoneum) around these organs. It is made up of 2 layers. One layer lines the wall of the abdomen. The other covers the organs.

The layers produce a small amount of fluid so that the organs in the abdomen can move smoothly. Sometimes fluid builds up between the 2 layers, which makes the abdomen swell. This can be very uncomfortable.

This fluid build up is called ascites.

The causes of ascites

Cancers that can cause ascites include:

• ovarian cancer
• breast cancer
• bowel cancer
• stomach cancer
• pancreatic cancer
• mesothelioma in the peritoneum
• lung cancer
• liver cancer
• womb cancer

Fluid can build up when:

• cancer cells irritate the lining of the abdomen and make it produce too much fluid
• lymph glands in the abdomen get blocked and can’t drain fluid properly
• cancer has spread to the liver and raises the pressure in nearby blood vessels, which forces fluid out
• the liver can’t make enough blood proteins so fluid leaks out of veins into the abdominal cavity

Other conditions that can cause fluid in the abdomen include:

• liver disease
• heart disease

What are the symptoms of ascites?

The fluid causes swelling that can make the tummy feel tight and very uncomfortable. It often develops over a few weeks but might happen over a few days.

The fluid causes pressure on other organs in the abdominal area and may lead to:

• clothes feeling tighter or needing a bigger belt size
• bloating
• abdominal pain
• back pain
• difficulty sitting comfortably and moving around
• loss of appetite
• indigestion
• constipation
• needing to pass urine often
• breathlessness
• tiredness and weakness (fatigue)
• feeling or being sick

Tests

You might have tests to find the cause of the swelling.

Your doctor examines you and asks about your symptoms. They may also ask you to have:

• an ultrasound scan
• blood tests to check your general health and how well your liver and kidneys are working
• a CT scan
• a sample of the fluid taken from your abdomen to check for cancer cells or infection

Your doctor puts local anaesthetic on the skin to numb the area. Then they put a needle into your abdomen to take a sample of fluid. They use an ultrasound scan to guide them. This can be uncomfortable but isn’t usually painful.

They use a syringe to draw out some fluid to send to the laboratory. In the lab, they examine it under a microscope to look for cancer cells.

• Cancer Priniciples & Practice of Oncology (11th edition)
  VT DeVita and others
  Lippincott, Williams and Wilkins 2018

• Cancer and its Management (7th edition)
  J Tobias and D Hochhauser 
  Wiley-Blackwell 2014

• Diagnosis and treatment of ascites
  EA Tsochatzis and AL Gerbes
  Journal of Hepatology, 2017, Volume 67, Issue 1, Pages 184–185

Last reviewed: 

26 Apr 2021

Next review due: 

26 Apr 2024

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Ascites: diagnosis and treatment

Ascites is an abnormal accumulation of fluid in the abdominal cavity. Among patients with ascites, the majority suffer from cirrhosis and portal hypertension. Ascites associated with malignant neoplasms is much less common: in about 7% of patients. Some patients have two causes of ascites at once – for example, cirrhosis and peritoneal carcinomatosis (multiple metastases in the peritoneum).

Why does ascites develop?

Ascites associated with malignancy can be seen in many tumors, including malignancies of the ovary, breast, colon, lung, pancreas, and liver. Lymphoma can also be complicated by ascites.

Ascites usually develops in the setting of recurrent or advanced cancer. Before ascites develops, patients may have peritoneal or hepatic metastases, enlarged intra-abdominal lymph nodes, or large tumor volume

The origin of the primary tumor influences the development of ascites.

• Malignant tumors of the ovary and bladder, as well as peritoneal mesothelioma, usually cause peritoneal carcinomatosis. In such cases, fluid accumulation is the result of blockage of draining lymphatic channels and increased vascular permeability.

• Cancer of the colon, stomach, breast, pancreas, and lung can cause peritoneal carcinomatosis and/or massive liver metastases, resulting in ascites, either due to fluid-producing tumor cells in the abdomen due to obstruction/compression of the portal veins leading to portal hypertension, or liver failure.

• Lymphomas may cause lymph node obstruction with accumulation of ascites, or symptomatic serous effusions.

Ascites in liver tumors

Ascites in patients with liver disease is usually due to hepatocellular carcinoma rather than liver metastases. The development of ascites may be the first sign of primary hepatocellular carcinoma of the liver.

The four most common ascites associated with hepatocellular carcinoma of the liver:

• in patients with chronic hepatitis B acquired in infancy or childhood,

• in patients with non-alcoholic fatty liver disease,

• in patients with chronic hepatitis C,

• in patients with alcoholic cirrhosis.

Under these conditions, ascites often develops when the volume of the tumor increases to such an extent that it replaces a critical part of the functional mass of the liver or leads to thrombosis of the portal vein.

Symptoms of ascites

Patients often seek medical attention because of abdominal pain, shortness of breath or early satiety, often swelling of the legs develops. Abdominal pain can be caused by a combination of factors, including nerve invasion by the tumor, distension of the liver capsule, or, in patients with large ascites, distension of the abdominal wall. Since ascites usually develops in the setting of a large tumor mass, patients usually lose weight before ascites develops (despite the added weight from the ascitic fluid itself).

Diagnosis of ascites

Diagnosis of ascites associated with malignancy is based on clinical presentation, imaging, puncture, and analysis of ascitic fluid.

Established cancer patients who develop ascites often do not require extensive evaluation. Since the development of ascites associated with malignancy is a poor prognostic sign, the diagnostic approach should focus on the rapid assessment and evacuation of ascites, with treatment aimed at improving the patient’s quality of life. On the other hand, the presence of ascites in a woman with epithelial ovarian cancer is not necessarily associated with a very poor prognosis.

Physical examination provides a rough estimate of the level of ascites accumulation. Patients with suspected malignant ascites should be examined to confirm the presence of ascites. The examination begins with an ultrasound of the abdominal organs, if necessary, a CT or MRI examination of the abdominal organs is connected.

Laparocentesis (puncture of the peritoneal wall) with the appropriate analysis of ascitic fluid is the most effective way to confirm the presence of ascites, diagnose its cause and determine if the fluid is infected and contains malignant cells.

Treatment of ascites

The main treatment for peritoneal carcinomatosis is therapeutic laparocentesis (evacuation of fluid from the abdominal cavity). The exception is ascites in ovarian cancer. For patients who cannot tolerate repetitive laparocentesis, peritoneal ports and catheters may be recommended. Patients with portal hypertension (those with massive liver metastases, cirrhosis with hepatocellular carcinoma, or malignant Budd-Chiari syndrome) may be given diuretics (drugs that increase urine output).

In patients with ascites from ovarian cancer, treatment options include cytoreductive surgery (removal of as much of the tumor and metastases as possible) and chemotherapy.

EMC Institute of Oncology, Moscow, st. Shchepkin, provides comprehensive care to patients with ascites according to modern international standards. Ascites can be evacuated both in a hospital and on an outpatient basis. Sometimes, in difficult cases, with poor tolerance of manipulation or at will, the patient can be hospitalized.

Hospitalization in EMC can be emergency – 24 hours a day, surgeons on duty are ready to assist in the evacuation of ascites.

causes and diagnosis, pelvic ultrasound

Sometimes, after an ultrasound examination, the doctor makes a note that the patient has fluid in the pelvis. In some cases, the presence of free fluid does not indicate any disease. This may indicate that the woman has ended ovulation, and after a while there will be no more fluid.

Unfortunately, more often the fluid in the pelvis indicates the development of pathology in the female genital organs. You can determine the disease after the procedure of ultrasound examination. The patient may feel some symptoms indicating the onset of the development of the disease. This is an increased body temperature, pulling or sharp pains in the lower abdomen, menstrual cycle failure.

Causes of fluid in the pelvis

Fluid accumulates in the pelvic region from the organ in which the pathology develops and the inflammatory process begins. Also, fluid may appear after an abortion. To find the cause of the disease, it is necessary to undergo an ultrasound of the pelvis. What diseases can be indicated by the presence of fluid in the pelvis.

• Endometriosis.

• Infectious disease leading to inflammation of the ovaries or uterus.

• Ascites. This is the accumulation of fluid caused by a malignant tumor.

• Ectopic pregnancy.

• Internal bleeding in the abdomen.

• Benign formation on the internal genital organs.

Before starting treatment, it is necessary to identify the affected organ and the cause of the inflammatory process. Only after an accurate diagnosis is made can treatment begin.

Treatment

After diagnosing fluid in the pelvis and identifying the affected organ, it is necessary to prescribe an effective treatment. It will be individual for each patient. As a rule, they begin with drug therapy. Most often prescribed:

• Antibiotics. They are used when there is an infection in the body. Thanks to them, the inflammatory process passes, which often causes the appearance of fluid in the pelvic area.

• Painkillers and anti-inflammatory drugs. Relieve inflammation and pain.

• Hormonal preparations. They are prescribed for violation of the menstrual cycle, as well as for diseases of the ovaries.

• Enzymes. Help fight inflammation.

• Vitamin complexes. Strengthen the immune system and the overall resistance of the body to infections.

All drugs should be taken strictly according to the doctor’s prescription, based on the diagnosis and taking into account contraindications, individual intolerance.

Prevention of fluid accumulation in the pelvis

Fluid in the small pelvis accumulates due to a disease of the internal organs of the small pelvis. Therefore, in order to avoid problems with the health of female internal genital organs, it is necessary to take preventive measures.

The main thing that women need to do is to lead a healthy lifestyle. Do not drink alcohol and do not smoke, these addictions adversely affect women’s health.