Ascites is defined as the condition where excess amount of fluid is abnormally accumulated in the abdomen. This gathering of fluid in the peritoneal cavity is also known as peritoneal fluid excess, peritoneal cavity fluid, hydro-peritoneum or abdominal dropsy.
What is Ascites?
The peritoneal cavity normally contains a few gallons of fluid which is naturally produced inside the abdomen. This peritoneal fluid is usually well-absorbed and does not normally accumulate. It circulates in a clockwise direction helping in the lubrication of intestines for their free movement.
When the fluid is not absorbed and starts getting accumulated, it indicates that the cancer cells are interfering with the process of absorption. This results in the swelling of belly similar to that of pregnant women.
Ascites can occur due to complications like trauma, appendicitis, perforated ulcer, colon inflammation or diverticulitis. It is also commonly found to develop when bacteria, intestinal and pancreatic juices or bile invade the transparent and smooth membrane lying on the peritoneum. Ascites is also linked more often with liver disease and other similar chronic conditions.
Ascites cirrhosis causes various changes that lead to weakness of kidneys affecting the excretion of sodium in urine. Pancreatic Ascites is noticed when a cyst bursts causing the pancreatic juices to invade the abdominal cavity. Ascites cancer shares 10 percent of the reported cases in the United States. Endocrine and renal ascites are some of the less common disorders. In the case of Ascites ovarian cancer, the fluid contains freely-floating cancer cells separated from the cancerous growths.
Some of the causes of ascites due to various illnesses are given below:
Ascites liver leads to the production of ascites due to two important factors.
- The decrease in the albumin levels in blood causes changes in the osmotic pressure which is necessary to avoid an exchange of fluids. Due to this, the ascites fluid flows out of the blood vessels.
- Rise in the pressure within the portal vein branches running through the liver. This increase in pressure leaks the blood into the abdomen due to its inability to pass through liver thus causing ascites.
Some other conditions that lead to the development of ascites are hepatitis, heart failure and kidney failure. Even inflammation of the sac containing heart, known as constrictive pericarditis) can lead to ascites.
Apart from these there are various other causes of ascites which are as follows:
- Hepatic congestion, congestive heart failure, tricuspid insufficiency, constrictive pericarditis and Budd-Chiari syndrome.
- Liver disease
- Alcoholic hepatitis
- Severe malnutrition
- Urine ascites and Ovarian disease
- Bile ascites, nephrogenic ascites and pancreatic ascites.
- Infections like bacterial peritonitis, fungal peritonitis, tuberculous peritonitis and HIV-linked peritonitis.
- Malignant ascites conditions like peritoneal carcinomatosis, hepatocellular carcinoma, primary mesothelioma and pseudomyxoma peritonei.
Apart from these, some other rare conditions that cause ascites are vasculitis, eosinophilic peritonitis, gamilial Mediterranean fever and granulomatous peritonitis.
Some other conditions that cause ascites and increase the risk are heavy use of alcohol, jaundice, intravenous drug use, homosexual activities, tattoos, untested blood transfusion and multiple sexual partners.
Malignant ascites is commonly seen in patients suffering from gastrointestinal cancer. It can be very painful compared to cirrhotic ascites.
Diabetes and nephritic syndrome also lead to nephritic ascites.
The careful physical examination and medical history of an ascites patient shows the symptoms only if the condition is a little severe. Ascitic fluids in small quantities do not generally show symptoms. The following are some of the symptoms of ascites:
- The skin across the abdomen is stretched and contains fluids in excessive amounts.
- The navel either bulges out or lies flat while the presence of fluid leads to dull sound when the abdomen is tapped.
- The presence of ascetic fluid results in the bulging of flanks.
- The abdomen of the patient is swollen and appears like that of a pregnant woman.
- Sudden weight gain can be a symptom of ascites. The increase in the amount of fluid in abdomen leads to increase in weight.
- Abdominal discomfort is caused due to the excessive fluid’s movement.
- Shortness of breath is observed in patients with ascites.
- Swollen ankles are another symptom of ascites, though it does not appear to have any connection.
- Patients with nephritic syndrome or cardiac illness may report of anasarca.
- A cardiac ascites can be suspected in case of an increased jugular venous pressure.
- The presence of a firm nodule in umbilicus indicates peritoneal carcinomatosis related to gastric, hepatic or pancreatic primary malignancy.
- The detection of a pathologic left-sided virchow node, or supraclavicular node, points towards the development of a malignant upper abdomen.
- Other findings include those similar to liver disease like jaundice, spider angiomas and portal hypertension.
- In case of large amounts of ascites, the liver becomes difficult to be palpated. Even if palpated, the liver is usually found enlarged. The sign of puddle can be noticed even when a small amount of fluid is present like about 120 ml. If the peritoneal fluid amount is more than 500 ml, the presence of ascites is highlighted by bulging flanks or shifting dullness. A fluid-wave sign is more often inaccurate.
The various methods for diagnosis of ascites condition include the following:
- CT scan
- Laboratory analysis of the fluid helps in the identification of the cause of ascites. The fluid can be extracted by inserting a needle through the abdominal wall by a procedure called as Diagnostic Paracentesis.
- Ascites can also be distinguished from obesity, ovarian tumors, intestinal gas and pregnancy by close physical examination.
The treatment for ascites starts with taking rest and going on a diet low on salt content. If the initial treatment of rest and change in diet doesn’t help much, then diuretics are prescribed. Diuretics are drugs that trigger urine. However, on prescription of diuretics, the weight along with the other urinary outputs of the patients must be monitored for the following signs:
There can be massive loss of blood or fluid leading to the condition of hypovolemia. A condition known as azotemia is also looked out for where there is an abnormal increase in the levels of nitrogen content in blood. Potassium imbalance can also be a cause of concern on using diuretics.
If there is a presence of high amounts of sodium then the doses of diuretics should be increased.
Moderate to large amounts of fluid accumulated in the abdomen can also be drained. This procedure involves less complication and safer compared to diuretic therapy. This method is also preferred for treating massive ascites. However, diuretics therapy can be repeated periodically to prevent further fluid accumulations.
Herbal diuretics like dandelion, or Taraxacum officinale, can help in eliminating excess fluids and also provide potassium which balances the presence or intake of excess sodium. Foods rich in potassium include mackerel, cantaloupe, and low-fat yogurt and baked potatoes.