Ascites is an abnormal buildup of protein-rich fluid in the abdomen. It can cause swelling and a gradually enlarging belly, abdominal discomfort, or trouble breathing.
This fluid buildup may happen with liver disease such as cirrhosis or portal hypertension, or with other conditions such as liver failure, kidney disease, or nephrotic syndrome.
Ascites treatment is managed by a primary care provider or hepatologist (liver specialist). It usually includes diuretics, limiting salt intake, or paracentesis to remove excess fluid from the abdomen.
Main symptoms
The main symptoms of ascites are:
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Swelling and progressively increasing abdominal size;
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Abdominal discomfort, with a feeling of heaviness and pressure in the abdomen;
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Indigestion or loss of appetite;
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Shortness of breath;
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Constipation.
Symptoms are related to an increase in the amount of fluid inside the abdomen. In the early stages, ascites may not cause symptoms; however, with large-volume ascites, symptoms are more likely due to the amount of fluid in the abdomen.
Ascites may also occur along with other symptoms such as an enlarged liver, fever, swollen legs and feet, confusion, or yellowing of the skin and eyes.
Confirming a diagnosis
Ascites is diagnosed by a primary care provider or hepatologist based on symptoms, health history, a physical exam, and lab tests.
Tests such as a complete blood count (CBC), X-ray, ultrasound, or computed tomography (CT) scan may be requested to help identify the cause of ascites.
A doctor may also perform a paracentesis procedure, which involves using a needle to collect a sample of fluid from the abdomen. This fluid is then sent to the lab for analysis, including a culture test to detect any bacteria present.
Possible causes
The main causes of ascites are:
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Cirrhosis, portal hypertension, or chronic hepatitis;
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Liver cancer or spread (metastasis) of other cancers to the liver;
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Congestive heart failure or pericarditis;
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Hepatic vein obstruction or acute liver failure;
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Kidney dialysis or kidney failure;
Ascites can also be caused by low blood albumin levels, peritoneal infections, pancreatitis, or tuberculosis, for example.
Can ascites be fatal?
Ascites that is not treated properly can be fatal due to an increased risk of bacterial growth in the fluid that has built up in the abdomen.
This can cause inflammation of the abdominal lining (peritonitis) and allow bacteria to spread into the bloodstream (bacteremia), potentially leading to sepsis and impaired organ function.
Treatment options
Ascites treatment should be guided by a hepatologist or primary care provider to reduce the amount of fluid in the abdomen, and varies depending on the underlying cause.
The main treatments for ascites are:
1. Diet changes
Diet changes for treating ascites include limiting sodium (typically no more than 2 g per day), especially in cases of portal hypertension, and stopping alcohol use.
In some cases, limiting fluid intake may also be recommended when blood sodium is below 125 mEq/L due to diuretic use.
An ascites diet should preferably be planned with a registered dietitian and tailored to the individual.
2. Use of medications
Medications for ascites are mainly diuretics, such as furosemide or spironolactone, which may be used when limiting dietary sodium is not effective enough to increase fluid removal through urine.
Spontaneous bacterial peritonitis is a serious, potentially life-threatening complication that occurs when the fluid from ascites becomes infected. In this case, doctors will prescribe antibiotics and hospitalization may be required.
3. Therapeutic paracentesis
Therapeutic paracentesis is used to remove fluid from the abdominal cavity by placing a catheter into the abdomen connected to a vacuum tube, and it is performed with local anesthesia.
This procedure is typically done in cases of large-volume ascites to relieve pain and abdominal discomfort or shortness of breath.
During therapeutic paracentesis, an intravenous (IV) infusion of human albumin may be needed to help prevent a drop in blood pressure.
4. Transjugular intrahepatic portosystemic shunt
A transjugular intrahepatic portosystemic shunt is a treatment option for ascites that does not improve with other treatments, because it reduces portal hypertension.
A transjugular intrahepatic portosystemic shunt treats ascites by reducing portal hypertension and is used in cases that do not improve with other treatments.
This treatment is performed by an interventional radiologist by inserting a catheter into the jugular vein, advancing it to the portal vein, and placing a stent to connect the portal vein to another vein in the liver, improving drainage and reducing fluid buildup in the abdomen.
5. Liver transplant
In cases of severe cirrhosis or liver failure, the doctor may recommend a liver transplant.
Can ascites be cured?
Ascites cannot be cured. However, doctor-recommended treatment can help relieve symptoms related to ascites and help prevent symptoms from returning.