Ascites

The most common cause of ascites is

Less common causes of ascites include disorders unrelated to the liver, such as cancer, heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more , kidney failure Chronic Kidney Disease Chronic kidney disease is a slowly progressive (months to years) decline in the kidneys’ ability to filter metabolic waste products from the blood. Major causes are diabetes and high blood pressure... read more , inflammation of the pancreas (pancreatitis Overview of Pancreatitis Pancreatitis is inflammation of the pancreas. The pancreas is a leaf-shaped organ about 5 inches (about 13 centimeters) long. It is surrounded by the lower edge of the stomach and the first... read more ), and tuberculosis Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more affecting the lining of the abdomen.

Ascites tends to occur in long-standing (chronic) rather than in short-lived (acute) liver disorders. It most commonly results from

Portal hypertension usually results from cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar... read more (severe scarring of the liver), which is most commonly caused by consumption of large amounts of alcohol, by fatty liver Fatty Liver Fatty liver is an abnormal accumulation of certain fats (triglycerides) inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms... read more , or by chronic viral hepatitis Overview of Chronic Hepatitis Chronic hepatitis is inflammation of the liver that lasts at least 6 months. Common causes include hepatitis B and C viruses and certain drugs. Most people have no symptoms, but some have vague... read more .

Ascites may occur in other liver disorders, such as severe alcoholic hepatitis without cirrhosis, other kinds of chronic hepatitis, and obstruction of the hepatic vein (Budd-Chiari syndrome Budd-Chiari Syndrome Budd-Chiari syndrome is caused by blood clots that completely or partially block blood flow from the liver. The blockage may occur anywhere from the small and large veins that carry blood from... read more ).

In people with a liver disorder, ascitic fluid leaks from the surface of the liver and intestine and accumulates within the abdomen. A combination of factors is responsible. They include the following:

Also, albumin usually leaks from blood vessels into the abdomen. Normally, albumin, the main protein in blood, helps keep fluid from leaking out of blood vessels. When albumin leaks out of blood vessels, fluid also leaks out.

Small amounts of fluid within the abdomen usually cause no symptoms. Moderate amounts may increase the person's waist size and cause weight gain. Massive amounts may cause abdominal swelling (distention) and discomfort. The abdomen feels taut, and the navel is flat or even pushed out.

The swollen abdomen puts pressure on the stomach, sometimes leading to loss of appetite, and pressure on the lungs, sometimes leading to shortness of breath.

In some people with ascites, the ankles swell because excess fluid accumulates there (causing edema Swelling Swelling is due to excess fluid in the tissues. The fluid is predominantly water. Swelling may be widespread or confined to a single limb or part of a limb. Swelling is often in the feet and... read more ).

When a doctor taps (percusses) the abdomen, the fluid makes a dull sound. If the person's abdomen is swollen because the intestines are distended with gas, the tapping makes a hollow sound. However, a doctor may not be able to detect ascitic fluid unless the volume is about a quart or more.

If doctors are uncertain whether ascites is present or what is causing it, they may do ultrasonography or computed tomography (CT; see Imaging Tests of the Liver and Gallbladder Imaging Tests of the Liver and Gallbladder Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, radionuclide scanning, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more ). In addition, a small sample of ascitic fluid can be withdrawn by inserting a needle through the wall of the abdomen—a procedure called diagnostic paracentesis Paracentesis Paracentesis is the insertion of a needle into the abdominal cavity for the removal of fluid. Normally, the abdominal cavity contains only a small amount of fluid. However, fluid can accumulate... read more . Laboratory analysis of the fluid can help determine the cause.

The basic treatment for ascites is a low-sodium diet with a goal of 2,000 mg or less of sodium per day.

If diet is ineffective, people are usually also given drugs called diuretics (such as spironolactone or furosemide). Diuretics make the kidneys excrete more sodium and water into the urine so people urinate more.

If ascites becomes uncomfortable or makes breathing or eating difficult, the fluid may be removed through a needle inserted into the abdomen—a procedure called therapeutic paracentesis. The fluid tends to reaccumulate unless people also follow a low-sodium diet and take a diuretic. Because a large amount of albumin is usually lost from the blood into the abdominal fluid, albumin may be given intravenously.

If large amounts of fluid accumulate frequently or if other treatments are ineffective, a portosystemic shunt or liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more may be needed. The portosystemic shunt Portosystemic shunting Portal hypertension is abnormally high blood pressure in the portal vein (the large vein that brings blood from the intestine to the liver) and its branches. Cirrhosis (scarring that distorts... read more connects the portal vein or one of its branches with a vein in the general circulation and thus bypasses the liver. However, placement of the shunt is an invasive procedure and can cause problems, such as deterioration of brain function (hepatic encephalopathy Hepatic Encephalopathy Hepatic encephalopathy is deterioration of brain function that occurs in people with severe liver disease because toxic substances normally removed by the liver build up in the blood and reach... read more ) and deterioration of liver function.

If spontaneous bacterial peritonitis is diagnosed, people are given antibiotics such as cefotaxime. Because this infection often recurs within a year, a different antibiotic (such as norfloxacin) is given after the initial infection resolves to prevent the infection from recurring.