Ascites is an abnormal condition in which the abdominal cavity is filled with excess fluid. Under normal conditions, there should be no fluid in the abdominal cavity or at least 20 milliliters or less in women. When the amount of fluid exceeds 25 milliliters, a person will appear bloated and swollen in the abdominal area.
The word ascites itself comes from the Latin word Askos which means bag or sack. The most common cause is cirrhosis of the liver. In addition, it can also come from malignancy and infection, such as tuberculosis, pancreatitis, heart failure, kidney failure, or blockage of the liver veins.
Fluid accumulation is rare in healthy people but develops as a result of other diseases, especially cirrhosis or liver disease. About half of people with decompensated cirrhosis will develop ascites. Cirrhosis accounts for about 80% of ascite cases.
Ascites Symptom
Ascites usually coincide with feelings of fullness, abdominal bloating, and weight gain. Other frequent symptoms include:
- Hard to breathe
- Nauseous
- Swelling in the feet and ankles
- Indigestion
- Vomit
- Indigestion
- Loss of appetite
- Fever
- Hernia
Ascites Reason
The occurrence of fluid accumulation can be divided into several categories, namely, transudate, exudate, and other causes. Causes of transudate include:
- Cirrhosis of the liver
- Heart failure
- Hepatic vein obstruction
- Heart infection (infective pericarditis)
- Malnutrition (kwashiorkor) in children
Meanwhile, the causes of exudate include:
- Cancer
- Infections, such as tuberculosis or bacterial peritonitis
- Pancreatitis
- Serositis
- Nephrotic syndrome
- Angioedema decreased
Other causes, such as:
- Meigs syndrome disease
- Vasculitis
- Hypothyroidism
- Kidney dialysis
- Tumor in the abdominal cavity (peritoneal mesothelioma)
- abdominal tuberculosis
- Mastocytosis
Ascites Risk Factors
Some conditions that cause a greater risk include:
-
- Non-alcoholic fatty liver disease.
- Hepatitis B and hepatitis C
- Alcohol use disorder.
- Autoimmune hepatitis.
- Genetic liver diseases such as hemochromatosis, Wilson’s disease, and alpha-1-antitrypsin deficiency.
- Congestive heart failure.
- Kidney disorder problems.
- Cancer of organs in the abdomen and pelvis.
- Infection.
Ascites Diagnosis
To diagnose fluid buildup, a doctor will usually perform several tests and a physical examination.
- Physical examination
The first step in diagnosis is to perform a physical examination. The doctor will examine the patient’s abdomen for signs of swelling or bloating.
- Blood Test
The doctor will do blood tests to show the presence of infection, liver damage, and kidney problems. In addition, to check the levels of albumin and bilirubin in the blood. Albumin is a protein production that comes from the liver. Low albumin levels can indicate liver damage. Bilirubin is a yellow pigment that comes from the liver and high levels can indicate liver damage or problems with the bile ducts.
- Radiology Examination
Radiological tests such as X-rays, CT scans, or ultrasounds can help your doctor see the fluid in your abdominal cavity and determine its size. They can also help your doctor determine the cause of ascites and look for signs of other diseases such as tumors.
- Ultrasound examination
An ultrasound (ultrasound) can help your doctor determine the size of the ascites and whether the fluid is coming from liver or kidney problems. An ultrasound can also monitor changes in the volume of fluid in the abdominal cavity.
- Paracentesis examination
Paracentesis is a medical procedure in which a doctor inserts a needle into the patient’s abdomen to remove a sample of fluid. This sample will then be analyzed in a laboratory to determine the cause of ascites. Paracentesis can also reduce fluid volume and relieve symptoms.
- Laparoscopic examination
Laparoscopy is a minor surgical procedure in which a doctor inserts a small endoscope into the patient’s abdomen to view the condition of the internal organs. Laparoscopy can help doctors determine the cause of ascites and look for signs of other diseases such as cancer.
Ascites Complications
Some complications that occur due to fluid accumulation in the body, namely:
- Abdominal problems: Fluid buildup can cause pain, discomfort, and difficulty breathing. These symptoms can interfere with your ability to eat, walk, and do daily activities.
- Infection: The fluid can become infected known as spontaneous bacterial peritonitis. Symptoms include fever and abdominal pain. This condition requires IV antibiotics and long-term antibiotic treatment to prevent re-infection.
- Liver hydrothorax, or fluid in the lungs: Abdominal fluid fills the lungs, usually on the right side. When this happens, you may experience shortness of breath, coughing, chest discomfort, and hypoxemia (low oxygen in the blood), so your doctor may need to perform a thoracentesis to remove the fluid.
- Hernias: Increased abdominal pressure can cause hernias, particularly umbilical and inguinal hernias.
- Kidney failure: If cirrhosis worsens, it can lead to kidney failure (hepatorenal syndrome).
Ascites Treatment
Ascites can be treated by paying attention to diet. Your doctor or dietitian will recommend a low-sodium diet. Reducing sodium, or salt, is the first line of therapy.
Your doctor may also prescribe diuretics, which cause your kidneys to excrete more sodium and water into your urine, causing you to urinate more often. Sometimes, diuretics aren’t enough, and fluid continues to build up. When this happens, you may have a procedure called therapeutic paracentesis. During a paracentesis, an interventional radiologist typically uses ultrasound to guide a needle into your abdomen and remove fluid from your body. If the fluid builds up again, the procedure is repeated.
However, if it does not work and fluid continues to build up, the radiologist will consider performing a TIPS ( Transjugular Intrahepatic Portosystemic Shunt ) procedure. During the procedure, a new pathway is created to connect the portal vein or one of its branches to the veins in the general circulation bypassing the liver. Meanwhile, shunt placement can increase fluid buildup and can also cause worsening of hepatic encephalopathy or liver function.
Ascites Prevention
The accumulation of fluid that can cause the risk of cirrhosis can be avoided by always maintaining a healthy lifestyle, such as:
- Eating healthy foods
- Regular exercise
- Enough rest
- Avoid using unsterile syringes.
- Avoid excessive alcohol consumption
- Don’t change partners
- Seek medical treatment immediately if you feel you have a medical complaint.