Ascites is the abnormal build-up of fluid in the abdomen. Ascites most commonly occurs as a complication of cirrhosis, particularly when the underlying chronic liver disease remains untreated. Sometimes ascites can also present with tumours in the abdominal organs. Ascites is treatable and various treatment options are available depending on the severity of the condition. Ascites itself is not life-threatening, but the fluid in the abdomen increases the pressure not just on the liver, but also on other organs, like the kidneys, spleen, bowel and pancreas. Furthermore, infection of the ascites fluid by bacteria can be dangerous and requires immediate medical treatment.
Causes of ascites
Ascites occurs when liver function is impaired: for example, if the underlying liver disease is not treated (antiviral treatment for viral hepatitis, abstinence for alcohol-related liver disease, weight loss for fatty liver disease). When inflammation and scarring in the liver increase, the blood can no longer flow properly through the small hepatic blood vessels. This leads to an increase in blood pressure in the portal vein and ascites may occur as a result. Ascites can also be the result of a liver tumour or thrombosis (formation of a blood clot) in the portal vein.
To begin with ascites barely has any symptoms because the amount of fluid in the abdomen is very low. However, when the volume increases, the pressure rises and the abdomen becomes larger and heavier. Ascites does not normally cause any pain, though the pressure can sometimes be disruptive, particularly because it makes breathing more difficult. Because of the increased pressure, ruptures may occur in the abdominal wall, develop at the umbilicus or in the area of the ducts. An infection of ascites manifests itself without particular symptoms, occasionally with fever, but can be very dangerous and must be treated with antibiotics.
Ascites first manifests itself with weight gain, which may also be associated with swelling of the legs. If the amount of fluid is small, the only way to see the fluid in the abdominal cavity is with an ultrasound examination. When the volume of fluid increases, the abdominal girth becomes larger and patients feel increasing pressure in the abdomen. In addition, the fluid accumulation can be easily seen and the possible ruptures of the abdominal wall become larger.
It is very important to treat the cause of the liver disease. This means that patients must not drink alcohol under any circumstances and must take medicines to combat the hepatitis virus.
After treatment it is very important to reduce the amount of salt consumed because sodium (an ingredient in table salt) strongly promotes the development of ascites.
If a low-salt diet is not sufficient, medications that increase water excretion by the kidneys (diuretics) can be taken under the guidance of a liver specialist.
In rare cases, e.g. if the diuretics do not work well enough, the ascites fluid must be repeatedly punctured. If this is the case, special treatments will also be evaluated, such as insertion of a TIPS (transjugular intrahepatic portosystemic shunt), implantation of an ascites pump (alfapump), insertion of a drain (PleurX), or even in extremely unique situations, a liver transplant.