Ascites is collection of fluid within the abdominal (peritoneal cavity). Ascitic fluid collection can be due to disease state affecting liver, heart, kidney and even cancers.
The most common cause of ascites is liver cirrhosis/scarring. Liver cirrhosis/scarring can be secondary to alcohol, fatty liver disease, hepatitis B and C. Cirrhosis causes an imbalance of pressure between the circulation (high pressure system) and the abdominal cavity (low pressure space). This pressure gradient along with decreased protein production (due to cirrhosis) results finally in ascites.
Ascites can also be a result of heart disease in the form of congestive heart failure or valvular heart disease. Ascites can also be a result of protein loss via urine from chronic kidney disease. Malignant ascites is a result of cancers.
As more and more ascetic fluid accumulates in the abdominal cavity, it results in increased abdominal girth. In addition symptoms include abdominal pain, shortness of breath, early satiety, and increased swelling in lower limbs. Because of decreased protein production, patients with cirrhosis are easily prone for infections especially the ascitic fluid infection which is called spontaneous bacterial peritonitis.
Usually the ascites if in large quantities results in cosmetically disfiguring large belly and easily identified on physical examination. However if ascitic fluid is less than 500 cc, physical examination assisted with an ultrasound examination can be used to diagnose the presence of ascites.
Ascites is a symptom and diagnosing the underlying illness resulting in ascites is the key. Usually blood work and occassionally liver biopsy is needed to diagnose the underlying liver condition.
Treatment depends on underlying conditions. Controlling the underlying disease treats ascites due to heart or kidney disease. Malignant ascites is treated with chemotherapy or radiation therapy of the underlying cancer. Since chronic liver disease is the major cause of ascites, will focus on treatment of ascites secondary to chronic liver disease.
Treatment of ascites secondary to liver disease has a 4-pronged approach:
Finally, liver transplantation for advanced cirrhotic liver disease can be considered at liver transplant institutes.