Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 2, 2016

Ascites is the buildup of fluid in the abdominal cavity. Located below the chest cavity and above the abdominal organs, the increase in fluids can lead to a rise in pressure throughout this region. It typically causes abdominal pain and abdominal bloating along with shortness of breath. Ascites is often a symptom of a more serious illness.


Definition & Facts

Ascites is a progressive condition that will typically continue to grow worse without treating the underlying cause. It is a dangerous condition because it can lead to more serious complications in addition to causing pain and shortness of breath.

Possible complications include hernias, infections, and hepatic hydrothorax (also known as pleural effusion in a patient with cirrhosis). With this condition, the fluid permeates the chest, fills the lung cavities and can even lead to heart failure. Patients with cirrhotic ascites have a 50 percent survival rate after two years, so it is vital that patients have this condition treated as soon as possible.

Symptoms & Complaints

Symptoms can settle in slowly over a period of time, or they can be acute. If it is only a small amount of fluid, there may not be any symptoms at all. As the fluid level continues to rise, it will lead to shortness of breath, bloating, and abdominal pain.

A distended abdomen is one of the first visible symptoms, and it is often accompanied by very mild discomfort. The pressure on the stomach and bowels can lead to a loss of appetite and even chronic nausea.

People may not know when to contact their doctor about abdominal pain or distension since some bloating is normal occasionally. Patients are encouraged to seek medical assistance if their bloating is accompanied by:


Ascites typically occurs as a result of more serious illnesses, including heart failure, pancreatitis, tuberculosis, and cirrhosis. It may also occur as the result of certain cancers, including stomach cancer, pancreatic cancer, colon cancer, or ovarian cancer. Hodgkin’s lymphoma and non-Hodgkin’s lymphoma result in this buildup of fluids, and a metastatic carcinoma in the abdominal cavity can result in the accumulation of fluids in this region.

In some cases, the sac-like coating around the heart may become thickened and scarred, and this can also lead to ascites. People who have problems with blood clots are also likely to develop this condition if they have blood clots in their liver's veinss (Budd-Chiari syndrome or hepatic vein thrombosis).

One of the most common causes is portal hypertension. With this condition, there is increased blood flow going to the liver without a way for the pressure to release. Sodium retention and water retention can also lead to ascites if certain sensors in the kidneys are malfunctioning. In this case, the kidney believes that the blood volume seems low (hypovolemia), and it will reabsorb salt and water to offset the perceived loss.

Diagnosis & Tests

Ascites can be diagnosed through a physical examination along with a detailed medical history. Patients who have some of the risk factors listed above, including certain cancers and other ailments, will be watched closely for this illness. When the fluid levels are high, the condition can be determined through bulging flanks and fluid waves. Smaller levels of buildup may be detected through an ultrasound. Computed tomography (CT) scans can also pinpoint the fluid, so some cases of ascites are found when evaluating patients for other illnesses.

Doctors may also request a 24-hour urine test or they may test electrolyte levels, renal function tests, and liver function tests. It is also possible to determine the function level of the kidneys through blood test, and this information can help doctors diagnose the condition.

One of the keys to treating ascites is determining the underlying cause. If other testing does not reveal answers, then a paracentesis may be performed to further examine a sample of the fluid.

Treatment & Therapy

Effective treatment of ascites relies on determining the primary cause and treating it accordingly. A number of causes center around the liver, so most treatment regimens will involve improving the health and function of this organ. This is accomplished through a healthy diet, reduction of sodium intake, and medication. Diuretics are commonly used to help eliminate the additional salt and fluids from the body.

If traditional treatments are not effective, then a therapeutic paracentesis may be conducted. This involves using a needle to safely remove large amounts of the fluid. Patients can have up to four or five liters eliminated in one session with this method, so it may be more effective than taking diuretics.

In some cases, surgery will be required to control the fluid accumulation. Physicians may be able to place a shunt between the veins to reduce the pressure and alleviate other symptoms. This option does carry substantial risks, including the increased possibility of death, so it is typically only used as a last resort.

Patients will typically be monitored closely for signs of secondary infections, and antibiotics may be used to prevent complications. Those who are going through end-stage liver disease may require a liver transplant to save their lives and stop the ascites.

Prevention & Prophylaxis

This condition cannot be prevented if there are underlying health concerns. However, people can adopt healthy lifestyle habits to reduce their risk of developing serious medical conditions. These include consuming alcohol in moderation, receiving the hepatitis B vaccine and being aware of medications that can cause liver damage.

People are also advised to maintain a healthy weight and dietary habits to reduce the risk of fluid buildup. Careful monitoring of patients with certain cancers and diseases can also lower the risk of developing ascites.

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