What is Ascites?
Ascites is the build-up of liquid inside the abdomen (belly). This disease is very common in patients with cirrhosis (cicatrization of the liver). Approximately 80% of patients with liver cirrhosis will develop ascites.
Ascites Symptoms: Some Signs You Should Not Overlook
The majority of people who suffer from ascites can develop a “large belly” . They will also experience substantial and rapid weight gain. Some people can also experience swelling in their ankles. Furthermore, they can also experience shortness of breath.
Let’s Expand on these Symptoms
- Bulky ascites, especially in people who are extremely thin, are incredibly easy to recognize. As we mentioned before, a patient with ascites will begin to show a significant enlargement on the abdomen.
- Patients with obesity or people who suffer from liquid retention might have ascites but it is mostly overlooked. In these cases, an ultrasound will help clear any doubts. An ultrasound can provide information on whether there is any liquid in the abdominal cavity.
- Generally, being able to detect any hepatic disease signs helps to identify underlying conditions like ascites. For example, a doctor will be able to detect any signs of jaundice (yellow-like skin). Moreover, if you are diagnosed with liver disease you may also experience liver enlargement, a presence of collateral irrigation in the abdomen area.
- Ascites may cause unease and discomfort in the patient. Occasionally, the amount of liquid is so large that it begins to enlarge the abdomen wall. This can also cause umbilical hernias, abdominal pain and breathing difficulties due to movement restriction in the diaphragm.
Children who are diagnosed with ascites may already show symptoms of heart failure, kidney and liver disorders.
Ascites may cause complications, for example some infections. Ascitic liquid may become quite large and bacteria located in the intestines may cause an infection. Bacteria may enter the peritoneal cavity, and infect ascites causing peritonitis.
Ascites: Risk Factors
The most common factors which help develop ascites are diseases that cause liver cirrhosis. These may include hepatitis B, hepatitis C, alcoholism or frequent alcohol abuse.
Other diseases which lead to a buildup of liquids can be congestive cardiac insufficiency and liver failure.
Complications Deriving from Ascites
- Abdominal Pain, Discomfort and Breathing Difficulties: These occur when a large liquid buildup is located in the abdominal cavity. These types of complications may limit the patient’s ability to eat, to walk around, and to do daily chores.
- Infection: Liquid located in your belly as a result of ascites may become infected by its proximity to the bacteria in the intestines (spontaneous bacterial peritonitis). This can normally lead to high fever and abdominal pain. Spontaneous bacterial peritonitis can be diagnosed by analysing a sample of the abdominal cavity (this test is called paracentesis). This disease is treated with intravenous administration of antibiotics. After controlling the infection, long term treatment with orally administered antibiotics is required in order to avoid the same infection in the near future.
- Liquid located in lungs. This is a disease called hepatic hydrothorax. The abdominal liquid begins to fill the lungs (mostly on the right side). This can lead to shortness of breath, coughing and hypoxemia (blood low on oxygen) and chest discomfort. One of the most recommended ways to treat hepatic hydrothorax is “removing” ascites through paracentesis.
- Kidney failure. A worsening case of cirrhosis can lead to kidney failure. This is called Hepatorenal Syndrome. It is a rare and serious condition.
Types of Ascites
Ascites can be divided into 2 types; transudative or exudative. The classification is based on how much protein is found in the fluid.
There is a test called SAAG for ascites. This can help discard possible causes for ascites. It measures how much albumin there is in the ascitic fluid. If it is greater than 1.1, causes can be related to cirrhosis or heart failure. If it is lower than 1.1, then the causes can be linked to pancreatitis, for example.
Under normal circumstances the amount of liquid located in the abdominal cavity can be almost null. In some cases, women might have small amounts of liquid freely located in the abdomen area. These amounts can vary from 10ml to 20ml during the menstrual cycle phases and they will not cause any problem or discomfort. This represents a very little amount of liquid compared to the amount a patient with cirrhosis can retain.
Ascites: Non Infected And Infected Ascitic Fluid
Not Infected Ascitic Fluid
This type of ascites occurs when the ascitic fluid is not yet infected. It is further classified into:
- Mild: it shows a small amount of fluid which can be spotted through an ultrasound.
- Moderate: it presents a proportioned distention and bloating of the abdomen.
- Severe: it causes an acute distention of the abdomen.
Infected Ascitic Fluid
- Noncompliant Ascites: This kind of ascites is diagnosed when a change of dietary habits or the use of diuretics is not enough to treat ascites. This will lead to a more disruptive treatment.
Ascites: What Can We Do About It?
Home Remedies and Treatment
There are a couple of ways to approach ascites. The easiest step is to transition to a diet which has the least salt as possible.
- Limit salt consumption as much as you can. This is the most important step towards facing ascites. The recommended limits are 2,000 mg or less every day. In order to drastically reduce your salt consumption, consulting with a nutritionist can be a great first step. These professionals can determine how much salt your food has, and this is something we need to learn about. They may recommend some alternatives for replacing salt which do not have any potassium.
- Patients may often need diuretic medication (commonly known as water pill) to treat ascites. These pills have to be prescribed by your doctor. Be sure to visit a certified dietician and your doctor to find the best possible treatment for you.