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

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 of fluid can lead to various complications and discomfort for those affected. But how exactly does ascites impact the body?

The effects of ascites on the body can be wide-ranging and potentially severe:

• Abdominal discomfort and pain
• Difficulty moving and reduced mobility
• Breathing problems due to pressure on the diaphragm
• Increased risk of abdominal infections
• Potential kidney complications
• Hernias in the abdominal area

Understanding the impact of ascites on the body is crucial for both patients and healthcare providers to manage the condition effectively and prevent further complications.

Common Causes and Risk Factors for Ascites

While ascites can have various underlying causes, certain factors are more commonly associated with this condition. What are the primary culprits behind ascites development?

The most frequent cause of ascites is cirrhosis of the liver. This chronic liver disease leads to scarring and impaired liver function, often resulting in fluid accumulation in the abdomen. However, other factors can also contribute to ascites:

• Excessive alcohol consumption
• Advanced or recurrent cancer
• Heart conditions
• Kidney problems, particularly in patients undergoing dialysis
• Low protein levels in the blood
• Infections within the abdominal cavity

Identifying the underlying cause of ascites is crucial for developing an effective treatment plan and managing the condition long-term.

Recognizing the Symptoms of Ascites

Early detection of ascites is vital for prompt treatment and better outcomes. How can individuals recognize the signs of this condition?

The symptoms of ascites can vary in severity and may develop gradually over time. Common indicators include:

1. Abdominal swelling and distension
2. Unexplained weight gain
3. A feeling of fullness or heaviness in the abdomen
4. Bloating and indigestion
5. Nausea and vomiting
6. Swelling in the lower legs (edema)
7. Shortness of breath, especially when lying down
8. Development of hemorrhoids

It’s important to note that these symptoms can also be associated with other medical conditions. Therefore, consulting a healthcare professional for an accurate diagnosis is essential if you experience persistent abdominal discomfort or swelling.

Diagnostic Approaches for Ascites

Accurate diagnosis of ascites is crucial for determining the appropriate treatment plan. How do healthcare providers confirm the presence of ascites and identify its underlying cause?

The diagnostic process for ascites typically involves a combination of physical examination and specialized tests:

• Physical examination: A healthcare provider will assess abdominal swelling and tenderness.
• Fluid sample analysis: A sample of abdominal fluid may be extracted using a needle (paracentesis) to check for signs of infection, cancer, or other underlying conditions.
• Imaging studies: Ultrasound, MRI, or CT scans can provide detailed images of the abdominal cavity and help quantify the amount of fluid present.
• Blood tests: These may be conducted to assess liver function, protein levels, and other relevant markers.

The combination of these diagnostic tools allows healthcare providers to not only confirm the presence of ascites but also determine its severity and potential causes, guiding treatment decisions.

Treatment Options and Management Strategies for Ascites

Managing ascites often requires a multifaceted approach tailored to the individual patient’s needs and underlying cause. What are the primary treatment options available for those diagnosed with ascites?

Treatment strategies for ascites may include:

1. Dietary modifications: Reducing salt intake is often the first line of defense against ascites. A low-sodium diet can help minimize fluid retention.
2. Fluid restriction: In some cases, limiting fluid intake may be recommended to help control ascites.
3. Diuretic medications: These drugs help increase urine production, reducing overall fluid volume in the body.
4. Paracentesis: For severe cases, large volumes of fluid may need to be removed directly from the abdomen using a needle.
5. Transjugular intrahepatic portosystemic shunt (TIPS): This advanced procedure creates a new connection between blood vessels in the liver to relieve pressure and reduce ascites formation.
6. Treatment of underlying conditions: Addressing the root cause, such as liver disease or cancer, is crucial for long-term management of ascites.

The choice of treatment depends on the severity of ascites, its underlying cause, and the patient’s overall health status. A healthcare provider will work closely with the patient to develop an individualized treatment plan.

Potential Complications of Untreated Ascites

When left untreated, ascites can lead to serious health complications. What are the risks associated with unmanaged ascites?

Potential complications of untreated ascites include:

• Spontaneous bacterial peritonitis: A potentially life-threatening infection of the abdominal cavity
• Hepatorenal syndrome: A severe form of kidney failure associated with advanced liver disease
• Pleural effusion: Accumulation of fluid around the lungs, leading to breathing difficulties
• Malnutrition: Due to decreased appetite and impaired nutrient absorption
• Increased risk of hernias: The pressure from ascites can cause weaknesses in the abdominal wall
• Reduced quality of life: Mobility issues, discomfort, and psychological distress

Understanding these potential complications underscores the importance of prompt diagnosis and effective management of ascites to prevent further health deterioration.

Lifestyle Changes and Prevention Strategies for Ascites

While not all cases of ascites can be prevented, certain lifestyle modifications can reduce the risk of developing this condition or help manage existing ascites. What steps can individuals take to minimize their risk?

Key prevention strategies and lifestyle changes include:

1. Abstaining from alcohol: Eliminating alcohol consumption is crucial, especially for those with liver disease.
2. Maintaining a healthy weight: Obesity can contribute to liver problems and increase the risk of ascites.
3. Regular exercise: Physical activity can help improve overall health and liver function.
4. Quitting smoking: Smoking cessation can reduce the risk of various health problems, including liver disease.
5. Limiting salt intake: A low-sodium diet is essential for preventing and managing ascites.
6. Practicing safe sex: This can reduce the risk of hepatitis infections, which can lead to liver problems.
7. Avoiding recreational drugs: Drug use can increase the risk of hepatitis and liver damage.

Implementing these lifestyle changes can not only help prevent ascites but also improve overall health and well-being. For those already diagnosed with ascites, these modifications can complement medical treatments and improve long-term outcomes.

The Role of Regular Monitoring in Ascites Management

Effective management of ascites requires ongoing monitoring and adjustment of treatment strategies. How can patients actively participate in their care?

Regular monitoring for ascites typically involves:

• Daily weight checks: Sudden weight gain can indicate fluid accumulation
• Abdominal measurements: To track changes in fluid volume
• Regular follow-up appointments with healthcare providers
• Periodic blood tests and imaging studies
• Monitoring of diuretic medication effectiveness and side effects

Patients should maintain open communication with their healthcare team, reporting any changes in symptoms or concerns promptly. This collaborative approach ensures that treatment plans can be adjusted as needed for optimal management of ascites.

Nutritional Considerations for Patients with Ascites

Proper nutrition plays a crucial role in managing ascites and supporting overall health. What dietary guidelines should patients with ascites follow?

Key nutritional considerations for ascites patients include:

1. Sodium restriction: Limiting salt intake to 2,000 mg or less per day
2. Adequate protein intake: To support liver function and prevent muscle wasting
3. Fluid management: Balancing fluid intake based on individual needs and ascites severity
4. Vitamin and mineral supplementation: As recommended by healthcare providers
5. Small, frequent meals: To manage feelings of fullness and improve nutrient absorption

Working with a registered dietitian can help patients develop a personalized nutrition plan that supports ascites management while meeting their overall nutritional needs.

Emerging Treatments and Research in Ascites Management

The field of ascites management is continuously evolving, with ongoing research into new treatment approaches. What promising developments are on the horizon for ascites patients?

Some areas of current research and emerging treatments include:

• Novel diuretic medications with improved efficacy and fewer side effects
• Targeted therapies for specific underlying causes of ascites
• Implantable devices for continuous ascites drainage
• Gene therapy approaches for liver disease-related ascites
• Immunotherapies for cancer-related ascites

While these treatments are still in various stages of development and clinical trials, they offer hope for improved ascites management in the future. Patients should discuss the latest treatment options with their healthcare providers to stay informed about potential new therapies.

The Psychological Impact of Living with Ascites

Dealing with ascites can take a toll on a patient’s mental health and quality of life. How can patients and caregivers address the psychological aspects of living with this condition?

Strategies for managing the psychological impact of ascites include:

1. Seeking support from mental health professionals
2. Joining support groups for patients with ascites or related conditions
3. Practicing stress-reduction techniques such as meditation or yoga
4. Maintaining open communication with family and friends about the challenges of living with ascites
5. Setting realistic goals and celebrating small victories in managing the condition

Addressing the psychological aspects of ascites is an essential component of comprehensive care. Healthcare providers should be prepared to offer resources and referrals to support patients’ mental well-being throughout their treatment journey.

The Importance of a Multidisciplinary Approach to Ascites Care

Managing ascites often requires the expertise of various medical specialists. Why is a multidisciplinary approach crucial for optimal patient outcomes?

A comprehensive care team for ascites management may include:

• Hepatologists or gastroenterologists
• Nephrologists
• Oncologists (for cancer-related ascites)
• Radiologists
• Nutritionists or dietitians
• Mental health professionals
• Specialized nurses

This collaborative approach ensures that all aspects of the patient’s health are addressed, from managing the underlying cause of ascites to addressing nutritional needs and psychological support. Regular communication and coordination among team members can lead to more effective treatment strategies and improved quality of life for patients living with ascites.

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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Ascites (excess abdominal fluid): Symptoms, treatment, and causes

Ascites is a buildup of fluid in the abdomen. It can happen when the liver is not working properly. Fluid fills the space between the organs and abdominal lining, leading to swelling and pain.

Ascites is a common symptom of cirrhosis, which is scarring on the liver.

As fluid accumulates in the abdomen, a person can feel bloated and uncomfortable. The fluid can also press on the lungs, causing shortness of breath.

Depending on the cause of a person’s ascites, a doctor can treat the condition with lifestyle changes, diuretics, and antibiotics. They may need to drain the fluid with a needle in some cases.

Read more to learn about what causes ascites, common symptoms, how to treat it, and more.

Ascites is the medical term for a buildup of fluid in the abdomen.

It can happen when the blood pressure of the portal vein — which runs from the digestive organs to the liver — gets too high. This increased pressure reduces kidney and liver function, causing fluid to accumulate.

The condition occurs in 80% of people with liver problems or cirrhosis.

Excess fluid in the abdomen can cause swelling, making the abdomen feel tight and uncomfortable.

The symptoms of ascites can develop over a few weeks or even days. While it may be minor at first, the swelling can become more severe.

Symptoms associated with ascites may include:

• abdominal pain
• bloating
• constipation
• indigestion
• loss of appetite
• frequent urination
• feeling breathless
• fatigue
• back pain
• swelling in legs and feet

Cirrhosis, or liver scarring, is the most common cause of ascites.

Other possible causes include:

• kidney failure
• heart failure
• infection
• pancreatitis
• portal vein thrombosis

Although ascites may look similar to belly fat, a doctor will be able to differentiate the two.

Ascites and fat move and feel different. A doctor may examine a person’s abdomen when lying down and standing. The shape of the abdomen may suggest that it contains fluid rather than fat.

A person with ascites may also have a distended abdomen, which is hard and swollen. They may also experience rapid changes in weight and body shape. These changes happen far more quickly than the rate at which a person typically gains body fat mass.

In most cases, ascites itself is not life threatening. However, the cause may be a more serious condition that may be life threatening, such as liver failure.

For people who have ascites as a complication of cirrhosis, mortality ranges from 15% in 1 year to 44% in 5 years.

If ascites is left untreated, an individual may have complications. For example, they may develop an infection in the fluid in their abdomen. This can be dangerous if not managed properly.

Diagnosis depends on how much fluid is present in a person’s abdomen. Doctors can often diagnose ascites through physical examination.

They may then confirm the diagnosis using an ultrasound or CT scan of the abdomen.

A doctor will also typically take a sample of the fluid by inserting a small needle through the abdominal wall under local anesthetic, extracting some fluid, and sending it for testing.

Doctors will examine the fluid for signs of cancer and infection to determine the reason for fluid buildup.

A person’s outlook depends on the reason for their ascites. If an infection causes a person’s ascites, antibiotics can treat it.

For most people with ascites from cirrhosis, paracentesis and shunts can improve their quality of life. However, they likely will not increase their chances of survival. They instead help manage the condition while a person waits for a liver transplant.

Ascites is a buildup of fluid in the abdomen. It commonly occurs as a complication of liver disease.

Symptoms include bloating, indigestion, constipation, and shortness of breath. Although it can be treated with medication and simple procedures, it can recur in people with chronic conditions.

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.