A condition called ascites occurs when fluid accumulates between the lining of the abdomen and the organs (peritoneum). Symptoms of ascites include swelling, discomfort, and weight gain. A serious underlying disease, such as liver cirrhosis, cancer, or heart failure, could be manifested as ascites.
Causes of ascites
Ascites is primarily caused by increased pressure in the blood vessels of the liver (portal hypertension). This can occur due to various factors, such as:
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Cirrhosis of the liver is a chronic disease caused by inflammation or infection that scars and damages the liver. It can result in fluid leakage into the abdomen and reduced fluid removal by the kidneys due to liver cirrhosis, which impairs the liver's ability to filter blood and produce proteins that regulate fluid balance.
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A liver cancer is a malignant tumor that begins in the liver cells or spreads from elsewhere in the body. It can cause portal hypertension by compressing or blocking liver blood vessels. Additionally, it can alter fluid balance in the body by producing substances.
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Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It can cause fluid retention in the legs, abdomen, lungs, and kidneys.
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In addition to kidney disease, pancreatitis, tuberculosis, ovarian cancer, or peritoneal dialysis, there are other conditions that can cause or contribute to ascites.
Symptoms of ascites
Ascites symptoms are determined by the amount and rate of fluid accumulation in the abdomen. Some of the most common symptoms are:
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Abdominal swelling or distension
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Abdominal pain or discomfort
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Difficulty breathing or shortness of breath
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Nausea or vomiting
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Loss of appetite or weight loss
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Bloating or gas
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Indigestion or heartburn
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Constipation or diarrhea
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Hemorrhoids or varicose veins
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Umbilical hernia (bulging of the navel)
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Stretch marks on the skin
A person with ascites may experience worsening symptoms over time and experience limitations in their daily activities and quality of life. Ascites may also increase the risk of other serious complications, such as:
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SBP is a life-threatening infection of the fluid in the abdomen that can cause fever, chills, abdominal pain, or shock.
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As a result of liver failure, toxins build up in the brain, causing confusion, drowsiness, mood changes, or even comas.
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In hepatatorenal syndrome, kidney function deteriorates due to liver failure, resulting in reduced urine output, swelling, high blood pressure, and jaundice.
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It can cause abdominal pain, bleeding, or intestinal ischemia when a blood clot forms in the portal vein, which carries blood from the digestive organs to the liver.
Diagnosis of ascites
Doctors will ask about your medical history, symptoms, and asbestos exposure to diagnose ascites. They will also perform a physical examination and check for signs of fluid accumulation, such as abdominal swelling, shifting dullness, or fluid wave. Ascites may also be diagnosed with tests that look for signs of infection or cancer in the fluid, as well as to check your liver and kidney function.
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An ascites patient's blood can be tested to determine the cause or severity of the condition by measuring albumin, creatinine, bilirubin, or liver enzymes. In addition to white blood cells, C-reactive protein (CRP), and procalcitonin, they can also detect signs of infection or inflammation.
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A urine test can determine the level of sodium, potassium, or creatinine in your urine, which may indicate your kidney function or fluid balance.
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Paracentesis: This procedure involves inserting a needle into the abdomen and draining some fluid for analysis. The fluid can be examined for its color, clarity, protein content, cell count, or culture. A biopsy can also be used to detect tumor markers, such as carcinoembryonic antigen (CEA) or cancer antigen 125 (CA 125), that may indicate the presence of abdominal cancer.
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Ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI), or X-rays are all imaging tests that provide images of the abdomen and its organs, such as fluid accumulation, liver damage, portal hypertension, and tumors.
Treatment of ascites
It is important to treat ascites according to the cause, amount, and symptoms of the fluid accumulation. Treatment options include removing excess fluid, preventing complications, and treating the underlying disease.
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Diuretics (such as spironolactone or furosemide), antibiotics (such as ciprofloxacin or norfloxacin), and beta blockers (such as propranolol or nadolol) can reduce fluid production.
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During a paracentesis, a needle is inserted into the abdomen and excess fluid is drained, providing immediate relief from symptoms and reducing abdominal pressure. Complications like infection or bleeding can also be prevented.
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By using a metal stent to create a new pathway between the portal vein and hepatic vein, the transjugular intrahepatic portosystemic shunt (TIPS) can lower the pressure in the portal vein and reduce fluid leakage into the abdomen. Blood flow to the liver and kidneys can also be improved.
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The peritoneovenous shunt involves inserting a tube from the abdomen to a large vein in the chest or neck. It can reduce abdominal swelling, improve kidney function, and increase urine output.
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It involves replacing the damaged liver with a healthy one from a donor. This can cure ascites caused by liver cirrhosis or cancer and restore normal liver function.
Prevention of ascites
Some possible ways to reduce the risk or severity of ascites include treating and controlling the underlying disease that causes it.
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Limiting or avoiding alcohol consumption, as alcohol damages the liver and worsens portal hypertension
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Salt can increase fluid retention and swelling in the body, so eat a low-salt diet
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Take your medications as prescribed by your doctor and monitor your blood pressure, weight, and urine output regularly
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The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can impair kidney function and increase fluid retention.
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You should seek medical attention as soon as possible if you experience symptoms of ascites or complications such as infection, bleeding, or encephalopathy
When fluid accumulates in the space between the abdomen's lining and its organs, it is called ascites. Symptoms of ascites include abdominal swelling, discomfort, and weight gain. Ascites can be a sign of a serious underlying disease such as liver cirrhosis, cancer, or heart failure. Depending on the cause and amount of fluid accumulation, ascites can be diagnosed and treated in a variety of ways. Proper management and care can prevent and control ascites.
