What Is Ascites?

This post was written with Consensus AI Academic Search Engine – please read our Disclaimer at the end of this article. Ascites is the pathological accumulation of fluid in the peritoneal cavity, often associated with liver diseases such as cirrhosis. It can also occur due to heart failure, kidney failure, or malignancies. The primary cause of ascites in cirrhosis is portal hypertension, which leads to increased pressure in the liver’s blood vessels, causing fluid to leak into the abdominal cavity1 2.

Pathophysiology

The development of ascites involves several mechanisms:

1. Portal Hypertension: Increased pressure in the portal vein system due to liver cirrhosis is a significant factor2.
2. Hypoalbuminemia: Reduced albumin levels in the blood decrease oncotic pressure, leading to fluid leakage1.
3. Sodium and Water Retention: The kidneys retain sodium and water due to the activation of the renin-angiotensin-aldosterone system (RAAS) and non-osmotic release of vasopressin10.

Clinical Presentation

Patients with ascites may present with abdominal distension, discomfort, and weight gain. Severe cases can lead to complications such as spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, and hepatic hydrothorax4 5.

Diagnosis

Diagnosis of ascites typically involves:

• Physical Examination: Detecting fluid wave or shifting dullness.
• Imaging: Ultrasound is the most common imaging modality used to confirm the presence of ascitic fluid.
• Paracentesis: Analysis of ascitic fluid can help determine the underlying cause and check for infections4.

Management

Management of ascites includes:

1. Dietary Sodium Restriction: Limiting sodium intake to reduce fluid accumulation.
2. Diuretics: Medications like spironolactone and furosemide are commonly used to promote fluid excretion1.
3. Paracentesis: Therapeutic paracentesis can be performed to remove large volumes of ascitic fluid, providing symptomatic relief4.
4. Albumin Infusion: Long-term administration of human albumin has been shown to improve survival in patients with decompensated cirrhosis and ascites1.
5. Transjugular Intrahepatic Portosystemic Shunt (TIPS): This procedure can reduce portal hypertension and is effective in patients with refractory ascites4.

Prognosis

The prognosis of patients with ascites largely depends on the underlying cause. In cirrhosis, the development of ascites is a marker of advanced liver disease and is associated with a poor prognosis. The Child-Turcotte-Pugh (CTP) score and Model for End-Stage Liver Disease (MELD) score are commonly used to assess the severity and predict outcomes in these patients7 9.

Conclusion

Ascites is a common and serious complication of liver cirrhosis and other conditions. Effective management requires a combination of dietary modifications, pharmacological treatments, and sometimes invasive procedures. Early diagnosis and appropriate treatment are crucial to improving patient outcomes and quality of life.

Disclaimer

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