Ascites: Causes, Symptoms, and Treatment

Ascites is the abnormal accumulation of fluid in the abdominal cavity. It usually occurs when the liver stops functioning properly. Fluid fills the space between the lining of the abdomen and the organs. This is a common problem in patients with cirrhosis of the liver.

What causes Ascites?

Ascites is most often caused by liver scarring or cirrhosis. This increases pressure inside the liver’s blood vessels. The increased pressure can force fluid into the abdominal cavity, where it accumulates causing ascites.

Though the main cause of ascites is usually cirrhosis, a liver disorder caused by excessive alcohol consumption or viral hepatitis, there are other conditions that can also lead to ascites. Some of these conditions include:

  • Chronic pancreatitis
  • Heart or kidney failure
  • Cancer
  • Tuberculosis

What are the symptoms?

Symptoms occur either slowly or abruptly, depending on the cause of the fluid buildup. Ascites is painful and usually causes a person to feel:

  • Rapid weight gain
  • Swollen abdomen
  • Shortness of breath
  • Abdominal pain
  • Bloating
  • Nausea and vomiting
  • Swelling in legs and ankles
  • Loss of appetite
  • Heartburn

What is the treatment?

The treatment of ascites mainly depends on the underlying cause. For ascites due to liver cirrhosis, the following treatments may be followed:

Diuretics

The most important step to treating ascites is to drastically reduce your salt intake. Often, patients will require drugs called diuretics (“water pills”). They increase the amount of salt and water leaving your body to reduce pressure within the veins around the liver. Two most common diuretics are Furosemide (Lasix) and Spironolactone (Aldactone). Diuretics make the kidneys excrete more sodium and water into the urine. These drugs can cause problems with blood electrolytes, and close monitoring by blood tests may be required.

Paracentesis

Sometimes fluids continue to build up in the abdomen despite use of diuretics and a restricted salt diet. In these cases, patients may need paracentesis to remove the large amount of excess fluid. Paracentesis involves a doctor inserting a needle into the abdomen and draining off the excess liquid. This treatment is used most commonly when the ascites is serious or persistent.

Surgery

In extreme cases, if other treatments are ineffective, a permanent tube called a shunt is implanted in the body. It reroutes blood flow around the liver. However, placement of the shunt is an invasive procedure and can cause problems.

Liver transplant may be considered if ascites does not respond to treatment. This is generally used for end-stage liver disease, and is usually reserved for patients with very severe cirrhosis whose livers are failing.