Ascites

Ascites is the abnormal accumulation of fluid in the peritoneal cavity, the space within the abdomen that houses the intestines, liver, and other organs. While it may start as a minor issue, ascites can become life-threatening if not diagnosed and managed promptly.

It is commonly associated with liver cirrhosis, but other conditions—such as cancer, heart failure, or infections—can also cause ascites.

Understanding the Peritoneal Cavity and Fluid Balance

The peritoneum is a thin membrane lining the abdominal wall and covering abdominal organs. Under normal circumstances, this space contains only a small amount of lubricating fluid. In ascites, this balance is disrupted, resulting in excessive fluid buildup that can affect organ function and overall health.

Causes of Ascites

The causes of ascites are diverse, but they are generally categorized as follows:

1. Liver-Related Causes (Cirrhotic Ascites)

• Cirrhosis (most common cause)
  Cirrhosis causes increased pressure in the portal vein (portal hypertension) and decreased albumin production, leading to fluid leakage.

• Alcoholic liver disease
  Chronic alcohol abuse can damage liver cells and lead to cirrhosis.

• Hepatitis B and C infections
  These viral infections can lead to chronic inflammation and scarring of the liver.

2. Malignant Ascites

• Caused by cancer spread to the peritoneal cavity, especially:

  • Ovarian cancer

  • Pancreatic cancer

  • Gastric cancer

  • Colorectal cancer

3. Cardiac Causes

• Right-sided heart failure

• Constrictive pericarditis

These conditions raise pressure in the venous system, pushing fluid into the abdomen.

4. Kidney-Related Causes

• Nephrotic syndrome: Causes low blood protein levels leading to fluid leakage.

5. Infections

• Tuberculous peritonitis

• Spontaneous bacterial peritonitis (SBP): Common in cirrhotic patients with ascites.

6. Other Causes

• Hypothyroidism

• Pancreatitis

• Lymphatic obstruction

Symptoms of Ascites

Ascites can develop gradually or rapidly. Mild ascites may cause no symptoms, but as fluid accumulates, the following signs may appear:

Common Symptoms

• Abdominal distension or swelling

• Weight gain (unrelated to diet)

• Shortness of breath (due to pressure on the diaphragm)

• Bloating and discomfort

• Loss of appetite

• Early satiety (feeling full quickly)

• Fatigue and weakness

• Swelling in legs (edema)

Severe Cases May Include

• Hernias

• Infections (SBP)

• Kidney dysfunction

• Hepatic encephalopathy

Complications of Ascites

If not managed in time, ascites can lead to serious health issues, including:

• Spontaneous bacterial peritonitis (SBP)

• Hepatorenal syndrome (kidney failure due to liver dysfunction)

• Respiratory difficulties

• Umbilical hernia

• Electrolyte imbalances

• Decreased quality of life

Diagnosis of Ascites

At Sparsh Diagnostic Centre, we use a combination of clinical evaluation and advanced imaging for a definitive diagnosis.

1. Physical Examination

• Shifting dullness and fluid wave tests during abdominal palpation

• Signs of underlying liver disease

2. Imaging Studies

• Ultrasound: Gold standard for detecting and quantifying ascitic fluid

• CT Scan or MRI: Helps determine the underlying cause, especially in malignancy or infection

3. Blood Tests

• Liver Function Tests (LFTs)

• Serum Albumin and Total Protein

• Kidney function tests

• Coagulation profile

4. Diagnostic Paracentesis

• Needle aspiration of ascitic fluid

• Fluid analysis includes:

  • Cell count and differential

  • Albumin level

  • Cytology (to detect cancer cells)

  • Culture and sensitivity (to detect infection)

5. Serum-Ascites Albumin Gradient (SAAG)

• A SAAG >1.1 g/dL suggests portal hypertension

• A SAAG <1.1 g/dL suggests non-portal hypertension causes like cancer or infection

Treatment of Ascites

Treatment depends on the severity, underlying cause, and complications. The goal is to relieve symptoms, prevent recurrence, and manage the primary disease.

1. Lifestyle and Dietary Changes

• Sodium restriction (<2g/day) is essential

• Fluid restriction in some patients (especially if sodium is low)

• Alcohol cessation in patients with alcoholic liver disease

2. Medications

• Diuretics: Spironolactone (first-line), often combined with furosemide

• Antibiotics: For bacterial infections or SBP

• Albumin infusions: To improve blood volume and kidney function in some cases

• Antivirals: If due to hepatitis B or C

3. Paracentesis

• Therapeutic paracentesis involves removal of large volumes of ascitic fluid

• Safe and effective for symptom relief

• Often combined with albumin replacement to prevent circulatory dysfunction

4. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

• A procedure to reduce portal hypertension

• Reserved for patients with refractory ascites or frequent recurrence

5. Surgery or Cancer-Specific Treatment

• Required in malignant ascites or cases due to obstructive tumors

6. Liver Transplantation

• The only curative treatment for patients with decompensated cirrhosis and refractory ascites

Prevention of Ascites

While not all cases are preventable, especially those due to malignancy or genetic conditions, several measures can reduce risk:

• Avoid excessive alcohol consumption

• Treat hepatitis infections early

• Maintain a healthy body weight

• Follow up on liver and kidney function regularly

• Adhere to a low-sodium diet if advised

• Avoid unnecessary overuse of NSAIDs, which can impair kidney function

Ascites in Special Populations

1. Ascites in Pregnancy

• Rare but can occur due to preeclampsia, hepatic rupture, or underlying malignancy.

2. Pediatric Ascites

• Often caused by nephrotic syndrome, liver disease, or malignancy

• Requires prompt evaluation

At Sparsh Diagnostic Centre, we offer comprehensive diagnostic services to help identify the cause of ascites and guide effective treatment.

🔍 Our Services Include:

• Abdominal Ultrasound & Doppler Studies

• Blood Tests: Liver function, kidney profile, electrolytes, viral markers

• Diagnostic Paracentesis with fluid analysis

• Home Sample Collection anywhere in Kolkata

🩺 Early diagnosis = Better outcomes.
Let our team help you get the answers you need.

Frequently Asked Questions (FAQs)

Q1: Is ascites life-threatening?

Yes, especially if caused by advanced liver disease, cancer, or infection. Prompt treatment is essential.

Q2: Can ascites go away on its own?

No. It usually indicates an underlying condition and requires medical evaluation and treatment.

Q3: How is ascites fluid removed?

Through a procedure called paracentesis, where fluid is drained via a needle inserted into the abdomen.

Q4: How often can paracentesis be done?

It can be repeated as needed, especially in refractory ascites, but frequent drainage requires monitoring for protein loss and electrolyte imbalance.

Ascites is more than just a swollen belly—it’s a serious symptom of an underlying condition that demands medical attention. Whether due to liver disease, cancer, or other causes, early diagnosis and targeted treatment are key to better outcomes.

If you notice persistent abdominal bloating, swelling, or discomfort—don’t ignore it. Visit Sparsh Diagnostic Centre for a thorough evaluation and compassionate care.

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Sparsh Diagnostic Centre – Your Partner in Digestive Health
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📞 Call: 9830117733 / 8335049501
🌐 Visit: www.sparshdiagnostica.com