The body requires fluids to function but, like anything, too much of a good thing can be detrimental. Some conditions lead to abnormal and harmful fluid buildup within the abdominal cavity, called ascites. Ascites is most commonly caused by elevated venous blood pressure as a result of liver cirrhosis, though heart or kidney failure, infections, and certain cancers may also be responsible.
Ascitic fluid can be drawn from the abdomen with a needle, using a process called paracentesis. To better characterize the source of the ascites, lab workers use the sample for multiple tests, including albumin, total protein, cell counts, and cultures.
In the early stages, an individual may not exhibit any symptoms of ascites, but as the fluid accumulates, a distended abdomen is often the first indicator, accompanied by pain and bloating. As the abdominal fluid builds, it pushes against the diaphragm and fills up the area surrounding the lungs, causing shortness of breath. Some people experience back pain and may develop constipation or bladder urgency. Excessive bruising, bleeding, and loss of appetite are also common.
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Fluid buildup can foster bacterial infections, called spontaneous bacterial peritonitis. The infection causes fever and pain, and because it often recurs, doctors generally prescribe long-term antibiotics. Buildup in the lungs as a result of ascites causes hepatic hydrothorax, which leads to shortness of breath, coughing, chest discomfort, and reduced oxygen in the blood. Rarely, people with cirrhosis develop kidney failure due to hepatorenal syndrome.
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Liver damage causes cirrhosis, and ascites usually occurs during the advanced stages of liver disease. Early signs of the condition can include rapid weight gain and a distended abdomen. Difficulty walking, breathing, and eating can occur with fluid buildup around the lungs. Swollen ankles are a common issue. Some people with cirrhosis and ascites also develop inguinal or umbilical hernias.
If it is caused by cancer, ascites is referred to as malignant. Individuals with breast, colon, ovarian, uterine, pancreatic, or gastrointestinal cancers often develop this type of fluid buildup. The symptoms include shortness of breath, lumps around the belly button, fatigue, and difficulty eating. A person may also experience hemorrhoids, nausea or vomiting, and indigestion. To treat these symptoms, doctors often prescribe diuretics or dietary changes such as reducing sodium.
Congestive heart failure occurs when the heart's ability to pump blood is inadequate to meet the many demands of the body. Fluid building up in the lungs can leak into the abdominal cavity and cause ascites. Pancreatic disorders cause fluid retention as a result of inflammation. This also develops into ascites and can lead to malnourishment as well. Meigs' syndrome causes a benign ovarian tumor associated with ascites and excess fluid in the lungs.
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About 80 percent of people with cirrhosis develop ascites. However, people with hepatits are also at an increased risk, specifically hepatitis B and C. Excess alcohol consumption can also significantly raise the likelihood of ascites.
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The management of ascites can include important lifestyle changes, in addition to medical treatment. Key steps include refraining from alcohol, adopting a low sodium diet, and avoiding the use of medications such as ibuprofen. Anyone who notices symptoms associated with ascites should seek the care of a medical professional.
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How a doctor diagnoses ascites depends on the amount of fluid in the abdominal cavity. Generally, he will perform an abdominal exam, possibly followed by an ultrasound or CT scan to better view the severity of the condition. Another diagnostic method, paracentesis, requires inserting a small needle through the abdominal wall to extract fluid from the peritoneum. Lab tests can determine the type of infection or if cancer is present.
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People with ascites are usually instructed to take diuretics and adopt a low-sodium diet. If the condition causes other symptoms, such as shortness of breath, it is common practice to extract the fluid from the abdominal cavity with a paracentesis procedure. If the doctor diagnoses or suspects spontaneous bacterial peritonitis, she may prescribe antibiotics. In more severe cases, the individual may require surgery. If cancer is the cause, a surgeon can implant a shunt to move the fluid from the abdomen into the bloodstream. Additionally, if other treatments are unsuccessful, the patient may be considered for liver transplant. If treatment does not stop fluid buildup from forming, the individual may have refractory ascites, which has a more negative prognosis.
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