Ascites

Causes

A person with ascites usually has severe liver disease. Ascites due to liver disease is caused by high pressure in the blood vessels of the liver (portal hypertension) and low albumin levels.

Cirrhosis and any illness that leads to it is a common cause of ascites. Long-term infections with hepatitis C or B and long-term alcohol abuse are two of the most common causes of cirrhosis.

People with colon cancer, ovarian cancer, endometrial cancer, pancreatic cancer, and liver cancer may develop ascites. Other conditions which may lead to this problem include:

Disorders that may be associated with ascites include:

• Clots in the veins of the liver (portal vein thrombosis)
• Congestive heart failure
• Pancreatitis
• Thickening and scarring of the sac like covering of the heart

Kidney dialysis may also be associated with ascites.

Symptoms

When just a small amount of fluid has collected in the belly, there may be no symptoms. Symptoms often develop slowly or suddenly, but a rapid buildup of fluid and symptoms may occur with some causes of ascites.

As more fluid collects, abdominal pain and bloating may occur. When a large amount of ascites is present shortness of breath may develop also.

Exams and Tests

A physical examination may reveal a swollen abdomen, or belly.

Test to evaluate the liver may be done, including:

• 24-hour urine collection
• Creatinine and electrolytes
• Kidney function tests
• Liver enzyme, bilirubin, coagulation, and serum protein tests
• Urinalysis

Paracentesis or abdominal tap may be performed. This procedure involves using a thin needle to pull fluid from the abdomen. The fluid is tested in various ways to determine the cause of ascites.

Treatment

The condition that causes ascites will be treated, if possible.

Treatment may include:

• Diuretics, or "water pills," to help remove the fluid; usually, spironolactone (Aldactone) is used first, and then furosemide (Lasix) will be added
• Antibiotics, if an infection develops
• Limiting salt in the diet (no more than 1,500 mg/day of sodium)
• Avoiding drinking alcohol

Procedures used for ascites that do not respond to medical treatment include:

• Placing a tube into the area to remove large volumes of fluid (called a large volume paracentesis)
• Transjugular intrahepatic portosystemic shunt (TIPS), which helps reroute blood around the liver

Patients who develop end-stage liver disease, and whose ascites no longer respond to treatment will need a liver transplant.

Possible Complications

• Spontaneous bacterial peritonitis (a life-threatening infection of the ascites fluid)
• Hepatorenal syndrome (kidney failure)
• Weight loss and protein malnutrition
• Mental confusion, change in the level of alertness, or coma (hepatic encephalopathy)
• Other complications of liver cirrhosis

When to Contact a Medical Professional

Anyone who has ascites and develops new abdominal pain and fever should contact their health care provider immediately.

Alternative Names

Portal hypertension - ascites

References

Runyon BA; AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49(6):2087-2107.

Mehta G, Rothstein KD. Health maintenance issues in cirrhosis.Med Clin North Am. 2009;93:901-915.

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds.Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.

Update Date: 10/16/2011

Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California.