What is Ascites?

Ascites is the term used to describe abnormal fluid accumulation in the peritoneal cavity. The peritoneal cavity is the space between your internal abdominal organs and your muscular abdominal wall.

Ascites occurs in people who have chronic liver failure. Most medical professionals will refer to chronic liver failure as cirrhosis. The liver is an essential organ for life. Normal, healthy liver helps the body digest fat and break down cholesterol, gets rid of toxins like alcohol and drugs, stores important sources of energy, and helps your body form blood clots when you are injured.

There are many causes of chronic liver failure. However, the most common cause of cirrhosis is drinking too much alcohol. Other common causes of cirrhosis are infection with the viruses Hepatitis B and/or Hepatitis C. Some people may develop cirrhosis simply from being obese, while other people develop liver failure from excess iron or copper in their liver.

Chronic liver failure can cause major, potentially life threatening complications. The complications of cirrhosis include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, variceal bleeding, and hepatorenal syndrome.

Ascites is very common in people with cirrhosis. Almost 85% of cirrhotic patients develop this pathologic accumulation of fluid in the peritoneal cavity.

When an cirrhotic individual with abdominal swelling due to fluid accumulation presents to his or her physician the first step is to perform an abdominal paracentesis. An abdominal paracentesis is done by injecting a long needle into the abdomen and filling a blood culture bottle with ascitic fluid for analysis.

If the fluid is not infected, people with ascites due to cirrhosis are treated with sodium restriction and diuretics. First-line treatment of cirrhotic ascites consists of restricting dietary sodium to no more than 2,000 mg per day. Diuretic medicines are also initiated. These diuretics include oral spironolactone [Aldactone] and furosemide [Lasix]. It is also terribly important that the person with ascitic cirrhosis refrain from alcohol. Complete abstention from alcohol is required in people with chronic liver failure from any cause.

Occasionally, alcohol avoidance, sodium restriction and oral diuretic medications are not enough to manage ascitic fluid accumulation. In these individuals serial paracenteses (ascetic fluid removal) may be required. When a person with cirrhosis reaches the point that serial paracentesis procedures are required to control ascites, a referral for liver transplantation should be expedited. People who are candidates for transplant may require a Transjugular intrahepatic portosystemic shunt (TIPS) to control their liver failure while awaiting transplant.