Ascites or ascites is the abnormal accumulation of free fluid in the abdominal cavity (peritoneum). It is not a disease in its own right. Ascites is a symptom that can occur in the context of various, mostly chronic diseases.
Ascites occurs in connection with some liver, kidney, heart and tumor diseases, among others. However, ascites most frequently occurs in the case of liver cirrhosis.
Ascites usually manifests itself as a noticeable bulging and swelling of the abdomen. This results in significant weight gain and an increase in the abdominal circumference. In addition, severe ascites makes the abdomen feel tense and bloated.
As the swollen abdomen also presses on the stomach and lungs, it can cause
- Discomfort,
- loss of appetite and
- shortness of breath
can be the result.
Man with ascites © donikz | AdobeStock
With ascites, fluid leaks from the blood vessels into the abdominal cavity. In most cases, this is caused by a disturbance in the blood flow to the liver or a reduced pumping capacity of the right heart.
In the case of chronic liver disease such as liver cirrhosis, ascites develops as follows: On the one hand, the liver produces less protein and albumin, which normally keeps the water in the blood vessels. On the other hand, the blood accumulates in the portal vein, which transports the venous blood from the abdominal organs to the liver(portal vein hypertension).
In addition, there is sodium and water retention in the kidneys, i.e. the kidneys excrete less sodium and water. As a result, there is more fluid than normal in the vessels of the intestines and the pressure increases.
The walls of the blood vessels are also more permeable to fluid due to increased vascular meability. This fluid cannot be retained in the blood vessels. As a result, the fluid is forced into the abdominal cavity, where it leads to ascites.
Other diseases can also cause ascites through similar mechanisms.
Ascites can be caused by various diseases. The most common cause of ascites is cirrhosis of the liver. Other liver diseases that can lead to ascites are
Other possible causes of ascites are
Ascites can also be caused by a lack of protein due to malnutrition.
Smaller amounts of fluid in the abdominal cavity usually cause little or no discomfort.
Ascites with large amounts of fluid in the abdominal cavity leads to abdominal swelling with a noticeable increase in weight and abdominal circumference.
The abdomen is then thick and bulging when standing and becomes somewhat flatter with protruding flanks when lying down. The belly button may also be flat or pushed outwards.
As the accumulation of fluid in the stomach presses on the stomach and lungs, ascites can also be associated with
- Discomfort,
- loss of appetite and
- shortness of breath
associated with it. In addition, some patients with ascites develop edema of the ankles, i.e. the ankles swell.
The diagnosis of ascites is based on
various diagnostic procedures are available.
The physical examination in particular plays an important role in the diagnosis of ascites. The doctor taps the abdomen and measures the abdominal circumference. When the abdomen is tapped (percussion), the fluid makes a dull sound. On the other hand, when the abdomen is tapped from the side, a wave is formed that can be felt on the other side.
In this way, ascites can be detected from a fluid volume of 100 ml in the abdomen.
A very quick and accurate method for diagnosing ascites is ultrasound examination (sonography). With its help, even the smallest amounts of fluid from 30 ml can be detected in the abdominal cavity.
A peritoneal puncture can be performed to clarify the cause of the ascites. This involves taking a sample of fluid from the abdominal cavity through the abdominal wall using a needle under local anesthetic. It is then examined in the laboratory for possible infectious agents, tumor cells and protein content.
Liver cirrhosis is a common cause of ascites © SciePro | AdobeStock
The treatment of ascites consists of treating both the cause and the symptoms. Both therapeutic approaches should be applied simultaneously.
The causative therapy of ascites aims to treat and, if possible, cure the underlying disease. Its success is the prerequisite for the long-term success of symptomatic therapy.
Symptomatic treatment of ascites aims to flush out or remove the accumulation of fluid in the abdominal cavity from the body. The treatment of the underlying disease is initially of secondary importance.
However, if the cause of the ascites is not remedied, the accumulation of fluid will return over time. The fluid is usually flushed out of the abdominal cavity
- with a peritoneal puncture (ascites puncture) and dehydrating
- dehydrating medication (so-called diuretics).
Peritoneal puncture (ascites puncture) is a minor routine procedure. It very rarely causes complications. The attending physician punctures the patient's abdominal wall with a hollow needle or cannula. He then drains the excess fluid from the abdominal cavity via a small tube. In this way, up to 2 liters of fluid can be removed per procedure.
Draining medication, known as diuretics, can also gently flush fluid out of the body. This is accompanied by a weight loss of no more than 500 grams per day.
The active ingredients spironolactone and furosemide, among others, are used here. In addition, this dehydrating therapy should be accompanied by
- a low-salt diet,
- a restriction of fluid intake and
- bed rest
be supplemented. A possible lack of protein and minerals should also be compensated for.
The prognosis for ascites depends on whether the underlying causative disease can be successfully treated. If this is not the case, fluid will continue to accumulate in the patient's abdomen.
The chances of curing ascites in people with liver cirrhosis, for example, are very poor. Only around 40 percent of those affected are still alive after one year, and less than 30 percent after two years.
