The abdominal cavity is the largest cavity in the body and home to the liver and most of the organs of the digestive system. The liver, along with the other organs of the abdomen, are held in place in part by a membrane called the peritoneum. Sometimes, if the liver has been damaged, fluid can begin to build up in this membrane and cause a series of symptoms. This condition is called ascites, and if left untreated, it can cause a variety of complications and even death.

What Is Ascites?

Ascites is the general term for an abnormal build-up of fluid in the abdomen. The term is usually only employed, however, when an amount of fluid greater than 25 milliliters is found in the peritoneum. The peritoneum has two layers; the parietal peritoneum covers the inner wall of the abdomen, and the visceral peritoneum surrounds the internal abdominal organs. The peritoneal cavity is considered a potential space between these two layers, but it only becomes a space when ascitic fluid starts to build up.

Causes of Ascites

There are numerous possible causes of ascites, though in the United States and other developed countries the most common cause is liver cirrhosis. Cirrhosis is a condition characterized by impaired liver function that is usually the result of liver disease. When the liver is damaged (in many cases because of long-term, excessive alcohol use), the body attempts to repair the tissue. As the liver is repeatedly damaged and repaired, scar tissue begins to form; over time, scar tissue replaces healthy tissue and leads to a loss of function.

The primary mechanism for cirrhotic ascites is related to high blood pressure in the portal vein, a blood vessel that brings blood from the gastrointestinal tract to the liver. When the liver is damaged and scarring becomes widespread, the hardened tissue interferes with proper blood flow from the portal vein. When the blood pressure in this vein is high (a condition known as portal hypertension), kidney function becomes impaired and both sodium and water retention increase and excess fluid starts to build up in the area.

About half of patients with liver cirrhosis will develop ascites at some point, and it is ultimately the cause of nearly 80% of all cases. Yet cirrhosis isn’t the only condition that can lead to ascites. Below are some additional relevant conditions and risk factors:

  • Hepatitis: Hepatitis is a condition characterized by inflammation of liver tissue, and it can have the same basic impact on liver function as liver disease. The inflammation damages the liver and the resulting scar tissue increases blood pressure in the portal vein. Hepatitis is most often caused by the viruses known as hepatitis B and hepatitis C.
  • Other liver disease: There are also a number of other liver diseases that can similarly lead to ascites. Examples include hemochromatosis, Wilson’s disease, liver failure, or liver cancer.
  • Kidney failure: One of the kidney’s main functions is to control fluids in the body. When that function is impaired as it is in kidney failure, it leads to excess fluid in the body. This can generally cause edema (swelling or bloating due to fluid retention) around the body as well as ascites in the peritoneum.
  • Congestive heart failure: When a person has heart failure, it means that the pumping function is impaired and can’t pump as much blood as normal. Not being able to pump as much blood leads to excess blood in the circulatory system, which in turn leads to fluid retention around the body as well as in the peritoneum.
  • Pancreatitis: Pancreatitis is an inflammation of the pancreas, a primarily digestive organ that secretes enzymes into the intestines to help break down food. Reduced function resulting from inflammation can lead to a buildup of pancreatic juices that can then leak out into the peritoneum.

Symptoms of Ascites

The main symptom of ascites is swelling in the abdomen that is the direct result of fluid buildup in the peritoneum. Depending on the severity of the condition, this can manifest as a large, swollen belly. Fluid retention leads to weight gain and abdominal pain, and the pressure of this added weight on the midsection of the body can also cause shortness of breath. Ascites can also cause digestive issues like loss of appetite, constipation, and indigestion. In cases where damage to the liver is involved, a yellowing of the skin called jaundice is also possible. Other symptoms may additionally present depending on the underlying cause.

Complications of Ascites

The nature of having one’s abdomen swollen with fluid can make regular tasks like eating, drinking, breathing, and moving around more difficult. The excess fluid can also lead to various infections that bring their own additional problems. One example is spontaneous bacterial peritonitis, an infection of the ascitic fluid in the peritoneum. Some of this fluid can also make it into the lungs and cause hepatic hydrothorax. Another complication is hepatorenal syndrome, which is a rapid deterioration of the kidneys due to cirrhosis or liver failure.

Treatment Options for Ascites

Since there isn’t a specific cure, the management of ascites tends to involve a combination of treating the underlying condition and reversing the accumulation of fluid. To diagnose the condition, a doctor will perform a physical examination usually followed by paracentesis, a procedure that involves sampling some of the excess fluid to test for diseases. CT scans, MRIs, or X-rays may also be used to see inside the abdomen. Once diagnosed, there are a number of options available for treatment:

  • Lifestyle changes: Even if the ascites has a specific cause, the doctor may recommend limiting dietary sodium intake in order to help prevent more fluid building up. Also, since alcohol is one of the main risk factors for the condition, you’ll need to stop drinking. You may also be directed to increase the amount of potassium in your diet; potassium is an electrolyte that helps remove sodium from the bloodstream.
  • Diuretics: One of the first medications the doctor will prescribe is a diuretic, also known as a water pill. Diuretics cause an increase in the production of urine that will hopefully reduce the excess fluid buildup. Examples of the medication include furosemide and spironolactone.
  • Shunt: In more severe cases, a transjugular intrahepatic portosystemic shunt can be surgically inserted into the abdomen to improve the flow of blood between the portal vein and the hepatic vein.
  • Transplant: If other interventions don’t work, a liver transplant may be necessary.

    Contact Cary Gastro

    Ascites is a relatively rare problem for most people, but it is a very real possibility for anyone who has liver disease. If you have noticed abdominal swelling or any of the other symptoms noted above, you should get checked by a doctor of gastroenterology. While the fluid buildup itself isn’t usually too problematic, it often is an indicator of a deeper problem. Cary Gastro is a leading provider of high quality digestive health care, and we are passionate about helping patients get healthy and improve their quality of life. Please contact us today to request an appointment.