Diseases

Ascites – Causes, Symptoms & Treatment

Ascites

Ascites or abdominal dropsy is an accumulation of fluid in the abdominal cavity and is usually a symptom of an advanced underlying disease with a mostly poor (unfavorable) prognosis. In the majority of cases, ascites correlates with liver cirrhosis .

What are ascites?

Ascites (also known as abdominal dropsy) is a pathological accumulation of fluid in the free peritoneal cavity (abdominal cavity), which usually manifests itself as a symptom of a progressive underlying disease with a mostly poor prognosis.

In most cases, ascites manifests itself in the form of an enlarged abdominal circumference or bulging abdomen with a stretched navel area, which is often preceded by flatulence ( bloating ). In some cases, an umbilical hernia (hernia umbilicalis) can develop as a result of the ascites.

Based on its appearance, ascites can be differentiated into serious (clear to yellowish), chylous (milky), hemorrhagic (bloody), and purulent (bacterial) ascites.

Causes

The most common cause of ascites is advanced liver failure such as cirrhosis (80 percent). Cirrhosis of the liver can be caused by drug and/or alcohol abuse, chronic hepatitis , autoimmune hepatitis, non-alcoholic steatohepatitis ( fatty liver hepatitis) and, in rarer cases, by hemochromatosis (iron storage disease) or Wilson’s disease (copper storage disease).

Importantly, as cirrhosis progresses, the liver becomes increasingly scarred This impedes blood flow, which leads to blood congestion in the abdominal cavity. The blood is pressed out of the vessels by the pressure and escapes into the free abdominal cavity. This process is additionally catalyzed by the reduced synthesis of blood proteins, especially albumin, by the increasingly insufficient liver.

In addition, malignant (malignant) tumors and inflammatory changes in the peritoneal cavity (peritonitis) or pancreas (pancreatitis) can cause ascites. Right-heart and renal insufficiency are also considered to be contributing factors.

Symptoms, Ailments & Signs

Ascites can present with a variety of symptoms, signs and symptoms. First, there is swelling of the abdomen, which is usually painless and increases as the disease progresses. There may also be an umbilical hernia, which is expressed by pain in the area of ​​the navel and the navel conspicuously arching forward.

Many sufferers gain weight and in some cases (for example, when there is concomitant peripheral edema ) also suffer from fluid retention in the arms and legs. Gastrointestinal problems can also occur. Typical symptoms include flatulence and diarrhea , but also nausea and vomiting .

Ascites can be recognized by the fact that the symptoms mentioned persist over a longer period of time and increase in intensity over the course of this. In addition, ascites often occurs in connection with inflammation of the peritoneum, cancer and other diseases. Those affected usually suffer from a general feeling of illness.

Over time, weight loss can lead to a deficiency in the body’s supply. Typical deficiency symptoms are dizziness , difficulty concentrating and a general decrease in physical and mental performance. Ascites can be clearly diagnosed on the basis of these symptoms .

Diagnosis & History

Ascites can be detected by palpation (touching) and percussion (tapping) of the abdomen from an accumulated fluid of about 1 liter. In addition, the diagnosis is backed up by abdominal sonography , which can detect fluid volumes from 50 to 200 ml.

If the cause is unclear, an ascites puncture with subsequent analysis of the punctured liquid and/or computer tomography is usually used. If the punctured fluid is milky or bloody, a laparoscopy should be used to determine whether trauma or tumors are the cause. Purulent ascites, on the other hand, indicates an inflammatory disease of the abdomen (peritonitis). In addition, if liver failure is suspected, the liver values ​​(above all albumin ) are checked.

If left untreated, pronounced ascites can lead to an inguinal hernia or umbilical hernia , a disturbed sodium-potassium balance, renal insufficiency and tachycardia . In general, the prognosis depends on the specific underlying disease. If ascites occurs in connection with cirrhosis of the liver, this is a poor prognostic sign, since about half of those affected die within 5 years of diagnosis.

On the other hand, ascites due to acute pancreatitis usually resolves once the underlying disease has healed.

Complications

Ascites is associated with various complications. Abdominal wall disease almost always causes hernias in the intestinal wall. The tears can become inflamed and lead to severe infections in the abdomen and intestines. The increased intra-abdominal pressure also increases the risk of hydrothorax and other damage to the gastrointestinal tract.

Furthermore, ascites can cause sequelae such as dyspnoea, an elevated diaphragm or an upside-down stomach. In addition to often severe pain, fever symptoms and feelings of pressure, a bacterial viral infection can cause other complications such as acute kidney failure . In cirrhosis of the liver, ascites increases the risk of variceal bleeding. A particularly dangerous complication is spontaneous bacterial peritonitis , a migration of intestinal bacteria to other parts of the body.

The disorder often occurs without significant symptoms, such as fever or abdominal pain, but is fatal in up to 50 percent of all patients. Complications can arise in the treatment of ascites if the intestinal wall is injured during an operation. If local anesthetic is administered, allergic reactions may occur. The diagnostic ascites puncture can trigger infections and heavy bleeding. Organs in the abdominal cavity are rarely injured.

When should you go to the doctor?

If ascites is suspected, a doctor should be consulted as soon as possible. If there is an unusual increase in weight or swelling in the abdomen, a doctor must clarify the cause. The same applies if you suddenly experience general discomfort, a feeling of pressure in the abdominal region or a stabbing pain under the breastbone. If these symptoms persist for more than a few days, it is advisable to seek medical advice. A doctor should also be consulted if flatulence or symptoms of constipation persist.

Blood in the urine or stool as well as vomiting or diarrhea are further warning signs that require medical clarification. Patients who have heart disease, peritoneal tumors, or acute pancreatitis should speak to a doctor.

A chlamydial or gonococcal infection, tuberculosis or an inflammatory vascular disease may also be the cause of ascites. Patients with a relevant medical history should have unusual symptoms evaluated immediately, since ascites may already have developed. Prompt treatment can then be vital.

Treatment & Therapy

The therapeutic measures for ascites depend on the extent and the underlying disease. In the case of mild ascites, drug therapy with diuretics (including spironolactone, xipamide, furosemide) in combination with minimal fluid intake (1.2 to 1.5 liters daily) aims to reduce or flush out the fluid in the free peritoneal cavity.

The kidney values ​​should be checked regularly, since flushing them out too quickly can cause kidney failure (hepatorenal syndrome). If drug therapy is unsuccessful or if there is pronounced ascites, paracentesis (ascites puncture) may be an option. Since high concentrations of blood proteins are drained off with the liquid, liver function should be checked. In the case of insufficient liver function, albumin substitution by infusions is indicated to compensate.

A TIPS (transjugular intrahepatic portosystemic stent shunt) to minimize pressure in the portal vein system or a peritoneovenous shunt, through which the fluid can be drained via a catheter , can also be implanted as part of a surgical intervention .

In principle, the underlying disease of the ascites should always be treated. Liver transplantation may be indicated if liver cirrhosis is present. Tumors or their metastases in the abdomen are usually treated with chemotherapy, while bloody or milky ascites as a result of trauma may have to be treated surgically.

Outlook & Forecast

The prognosis for ascites depends on the underlying disease. Since this is not an isolated disease but a consequence of previous illnesses, the cause of the underlying disease must first be found and treated. If this succeeds, the ascites also completely regresses until it has completely disappeared.

For serious diseases such as cancer , the prognosis depends on the time of diagnosis and the type of tumor . If it is easy to treat and if it is discovered early, there are often good chances of recovery. This changes as soon as the tumor has spread or there is already extensive damage to the tissue.

In the case of a chronic underlying disease, the prognosis is also less optimistic. Chronic diseases have a progressive disease course. As a result, the number of complaints is steadily increasing. During treatment, an attempt is made to influence the course of the disease and to delay the progression for as long as possible. In addition, individual symptoms are combated as far as possible. Nevertheless, there is rarely a chance of recovery.

In order to minimize the symptoms of ascites, the excess fluid is drained off during one treatment. However, since it forms again due to the disease, this is not an intervention that can bring about a cure.

Prevention

Ascites can be prevented by consistent therapy of the potential underlying diseases. In most cases, ascites is also accompanied by liver cirrhosis, which is caused in particular by alcohol and drug abuse. Vaccination against inflammatory liver disease (hepatitis) is also a prophylactic measure against ascites.

Aftercare

Follow-up care after ascites depends largely on the causative disease and the course of the disease. If the underlying condition is positive, follow-up care must initially take place every two weeks or monthly. During the follow-up checks, the doctor will, among other things, measure the blood values ​​and, if necessary, also carry out a physical examination and take samples from the abdominal cavity again.

In addition, an anamnesis is carried out. Depending on the underlying condition, the doctor will ask about any accompanying symptoms of abdominal dropsy and the general condition of the patient and include them in the further planning. If no complications occur during treatment and the ascites subsides as planned, the intervals between follow-up checks can be extended.

If the ascites occurs without any other symptoms, it must be checked whether another, previously undiscovered cancer is the cause. Further investigations are then necessary for clarification. In a few patients, fluid retention is again noted during follow-up. Then an indwelling catheter or a permanent drainage must be placed. If a permanent drainage was placed as part of the therapy, it must be checked and removed if necessary. In addition, any accompanying symptoms must be clarified, which must be cured after the actual therapy.

You can do that yourself

In the case of ascites, medical treatment is based on the extent of the symptoms and the causative disease. Mild ascites does not necessarily require comprehensive therapy. It is usually sufficient to take gentle diuretics, which, in combination with rest and bed rest , promise rapid relief. At the same time, the fluid intake must be reduced to ensure that the infected fluid is flushed out.

After the acute phase, the body’s water balance must be rebalanced by taking in more fluids. At the same time, the diet has to be changed. With a healthy and balanced diet , which is best prepared in cooperation with a nutritionist, the symptoms should go away quickly. However, should complications arise, the doctor responsible must be informed. A recurrence may have formed or there is another problem that needs to be clarified and, if necessary, treated.

If an operation is to be carried out, the patient must take it easy. Physical activities should be avoided after the operation. This applies in particular if there is a serious underlying disease such as a tumor. In the case of bloody ascites, further medical examinations are necessary after the operation.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.