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Definition

Ascites is the accumulation of excess fluid in the abdominal cavity.

Ascites

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Causes

Ascites can be caused by:

  • High blood pressure in the portal venous system, which can be caused by:
    • Liver damage called cirrhosis — This is the most common cause of ascites.
    • Heart failure
    • Blockage of the large vein in the abdomen called the vena cava
  • Malnutrition or other conditions leading to low amounts of protein in the blood
  • Certain cancers
  • Infections, such as certain bacteria and parasites or tuberculosis that can invade the abdomen
  • Pancreatitis
  • Kidney disease
  • Abdominal leakage of lymph fluid
Risk Factors

Factors that increase your chance of ascites include having any of the conditions above.

Symptoms

Symptoms may include:

  • Increased abdominal circumference
  • Shortness of breath
  • Abdominal pain and/or distention
  • Pain on the side of the abdomen
  • Rapid weight gain
  • Difficulty breathing while lying flat
  • Decreased appetite
  • Heartburn
Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests to determine cause may include:

Imaging tests look for amount and distribution of fluid, and strctures inside abdomen. These may include:

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Dietary Changes
  • Sodium restriction—Limiting salt intake to 2,000 mg per day or less is often recommended to reduce or delay fluid build-up. More extreme restrictions in salt intake do not further improve outcomes.
  • Fluid restriction—if sodium level is too low.
  • Alcohol restriction—Ascites commonly occurs in people who have liver disease. Consuming alcohol can further impair liver function. Stopping alcohol use may limit the progression of ascites.
Diuretics

Diuretic medications are drugs that cause the kidneys to excrete more sodium and water in the urine. These medications are often recommended as the treatment of choice for ascites, along with sodium restriction.

Paracentesis

Ascites can be treated by inserting a hollow needle into the abdomen and removing excess fluid through the needle.

Surgery

If the other treatments are not effective and the ascites keep coming back, surgery can be done to divert blood away from the liver. If this is not successful, a liver transplant may be necessary.

If you are diagnosed with ascites, follow your doctor's instructions .

Prevention

To decrease the risk of ascites, take the following steps to prevent cirrhosis, the most common cause of ascites:

  • Drink alcohol only in moderation. This means no more than one drink per day for women and two for men.
  • Practice safe sex to avoid hepatitis.
  • Do not share IV needles.
  • Get vaccinated for hepatitis B.
  • If you are taking medications that can damage your liver, follow your doctor's instructions closely.

RESOURCES:

American Liver Foundation
http://www.liverfoundation.org

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Alcohol-induced liver disease. Liver Foundation website. Available at: http://www.liverfoundation.org/abouttheliver/info/alcohol. Updated October 4, 2011. Accessed June 25, 2013.

Ascites. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 13, 2014. Accessed June 16, 2014.

Cirrhosis. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/index.aspx. Updated February 21, 2013. Accessed June 25, 2013.

Runyon BA. Care of patients with ascites. N Engl J Med . 1994;330(5):337-342.



Last reviewed June 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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