Cirrhotic ascites

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

Cirrhotic ascites is frequently an end-stage condition of chronic liver disease. An accumulation of fluid in the abdomen is a common clinical finding in a patient with advanced cirrhosis of the liver. The abnormal fluid retention is called ascites. When the condition presents it generally signifies decline of health status and a poor prognosis.

Contents

Definition & Facts

Cirrhosis is a liver disease defined by inflammation, cell degeneration and scarring of liver tissue. Blood must flow through the liver for proper functioning of the organ, and scarring, combined with portal hypertension, slows blood flow through veins from the intestine, spleen, stomach, and pancreas. All of these veins empty into the large portal vein of the liver.

Progressive liver damage from cirrhosis causes hypertension and blocking of the portal vein, resulting in a large abdominal fluid accumulation. Within a 10-year period, about 60 percent of those with cirrhosis of the liver will develop ascites. Cirrhosis and chronic liver disease kill 36,427 people in the United States every year according to the Centers for Diseases Control and Prevention.

Symptoms & Complaints

Sudden weight gain with abdominal distension, pain, and difficulty breathing are symptoms of cirrhotic ascites. Large amounts of fluid may cause the navel to protrude.

Loss of appetite typically occurs. Ankles can accumulate some of the fluid, causing edema, or swelling. There will typically be flank or side fullness and abdominal pain. Sometimes there are no complaints, but traces of fluid are detectable upon a physical exam or imaging procedure.

Causes

Cirrhotic ascites is most frequently caused by alcoholism or chronic heavy alcohol consumption. When heavy drinking habits extend for a long period of time, typically eight or more years, the body replaces the liver's healthy tissue with fibrotic tissue.

Heavy consumption is considered to be five or more drinks a day for at least five of the past 30 days. When chronic alcohol abuse occurs, the liver cannot work as well as it should. Vital proteins cannot be produced nor toxins filtered from the blood. 10 to 20 percent of heavy drinkers will develop cirrhosis.

Being a woman increases the risk of cirrhotic ascites, as females have fewer stomach enzymes to break down alcohol particles. Therefore, more liver function is needed to clear alcohol from the system. Scar tissue is thus formed more frequently. Women are more at risk of alcohol-related liver disease in general than men.

Although alcoholism is a primary cause of cirrhotic ascites, a range of other conditions can cause the symptoms. Viral hepatitis such as hepatitis B and hepatitis C, cystic fibrosis, iron buildup (hemochromatosis) or Wilson's disease in which copper accumulates in the body, side effects of certain medications, infections, autoimmune disease, and gastrointestinal diseases may all cause cirrhotic ascites. Bile duct disease can result in bile flowing into the liver, which then scars the liver.

Diagnosis & Tests

Ascites is more difficult to detect by physical examination in a patient who is obese. Physical examination of abdominal distension and weight gain can confirm diagnosis of cirrhotic ascites. Abdominal paracentesis may be ordered. In this procedure, a needle is inserted into a quadrant of the abdomen, and fluid removed for examination.

The fluid will be examined to determine whether a person has ascites due to portal hypertension, trauma, cancer.

Treatment & Therapy

By the time a person develops cirrhotic ascites, treatment may be defined as management of the disease, because ascites is associated with a 50 percent mortality rate over two years.

  • Bed rest for those with cirrhosis and ascites is considered valuable, because an upright position is associated with lower sodium removal and poor response to diuretics due to reduced kidney filtration function. Diuretics are given to facilitate fluid removal by the body. Bed rest is associated with muscle atrophy, so this treatment must be monitored closely.
  • Salt restriction which includes eating a low sodium diet is associated with faster removal of the ascites fluid with diuretics and shorter hospital stays.
  • Therapeutic paracentesis is a method of removing fluid with a paracentesis needle. The method is considered to be more efficient than diuresis and a faster return to home.
  • Antiviral drugs may be necessary to treat any underlying infections causing the individual's cirrhosis.

Ascites usually recurs after all three of these treatments. Cirrhotic ascites is considered part of end-stage liver disease and liver transplantation may be an option. Waiting lists are very long, and 17 percent of those on the list will die annually. Many are not good candidates for liver transplant, because end-stage liver disease presents a group of complications and symptoms that could seriously affect transplant survival and quality of life.

Prevention & Prophylaxis

Preventing cirrhotic ascites involves reducing one's risk of developing cirrhosis. Drinking alcohol in moderation or abstaining from alcohol altogether is the primary preventative method against developing cirrhotic ascites because of how frequently alcoholism causes cirrhosis.

If one believes one has a problem with alcohol, one can seek treatment through psychotherapy (one type of this is cognitive behavioral therapy), support groups and twelve-step programs like Alcoholics Anonymous.

Getting vaccinated for hepatitis can also help reduce one's risk of developing cirrhosis that is caused by viral infections. Safe sex and avoiding intravenous drug use if sharing needles may reduce the risk of other kinds of hepatitis that cause cirrhosis.

Eating a healthy diet and regularly exercising are means by which one can maintain one's overall health and stave off disease more generally. To the extent that certain types of cirrhosis are caused by obesity (nonalcoholic steatohepatitis or non-alcoholic fatty liver disease), maintaining a healthy weight can help reduce the risk of developing this kind of cirrhosis.