Ascites are usually signs of advanced disease with a poor prognosis; in 75% of cases, cirrhosis is the cause. The amount of liquid in the accumulated water can be enormous and well over ten liters. The patient notices the first thing is an increase in waist size; Pants and belt no longer fit. Later the ascites lead to feelings of pressure and nausea, sometimes even to shortness of breath. To relieve the discomfort, doctors try to reduce the abdominal fluid. It is treated with diuretics, punctures, and shunts.
What Causes Ascites?
With ascites, fluid, often with cells, blood components, and protein, enters the abdominal cavity. The reasons for this are very different:
- Portal Hypertension
For example, if the veins' pressure in the abdomen rises, fluid "pushes" out of the vessels into the abdominal cavity. This happens when the blood builds up in the portal vein (high portal pressure). Such an increase in the portal vein's pressure occurs primarily in liver cirrhosis and liver cancer, and right heart failure or portal vein thrombosis.
- Cancer
If malignant tumors and metastases block the lymph drainage on the peritoneum (Peritoneal cancer) - less fluid and lymph are absorbed from the abdomen. Malignant tumors actively "sweat" water into the abdominal cavity themselves; tumor cells are often found in the ascites. Also, malignant tumors often produce proteins that stimulate the formation of new blood vessels. These new blood vessels are often incredibly porous, which in turn causes more fluid to enter the abdomen.
- Inflammation
If there is inflammation in the abdomen, the blood flow increases, and the cell walls become more permeable. As a result, fluid and often inflammatory cells get into the abdominal cavity. This mechanism plays a role in peritonitis or acute pancreatitis.
Due to the mechanisms described above, fluid increasingly accumulates in the abdomen. At first, the patient usually does not notice the ascites. If it becomes several liters, the waist circumference and weight increase, and clothing items no longer fit. Often the depression of the navel flattens out; occasionally, there is an umbilical hernia. If the abdominal fluid pushes the diaphragm upwards, there is also shortness of breath.
What Are The Treatments For Ascites?
The primary treatment measure is the therapy of the underlying disease by delaying cirrhosis progression, surgically removing a tumor, or treating inflammation. To relieve the symptoms caused by the ascites themselves, doctors try to reduce the amount of fluid in the abdomen. There are various methods of doing this.
- Basic Measures
Depending on the composition and cause of the ascites, salt and fluid intake control is necessary. The patient may not drink more than 1.5 liters of liquid and consume 5 g of salt per day. To control water retention, the patient must also weigh himself daily.
- Diuretics
The doctor tries to flush the fluid out of the body through the kidneys with diuretics. Here he often uses spironolactone, in some cases also combined with furosemide. During therapy with diuretics, the doctor closely monitors the kidney values and sodium and potassium in the blood, as these can change with medication.
- Ascites Puncture
If the treatment with diuretics is not sufficient, the doctor will draw off the liquid with a cannula or hollow needle. In this way, 0.5–1.5 liters are removed per puncture, which the patient immediately perceives as a relief.
- Permanent Drainage System
If ascites continue to run into the abdominal cavity despite the puncture, the doctors also alleviate the symptoms by draining the ascites outwards through a plastic catheter. The catheter is attached to the abdominal wall with plaster. Then you connect a tap through which the patient can control the drainage of the liquid himself.
Final Words
Ascites can be efficiently and reliably determined using an abdominal ultrasound. It is more difficult to find the cause of the ascites. Therefore, the doctor often punctures a newly formed ascites to analyze its composition and thus find out the origin of the fluid. The doctor looks in the ascites for proteins, red and white blood cells, tumor markers, tumor cells, or bacterial pathogens.
In addition to a physical examination and analysis of the punctured ascites, the doctor uses laboratory tests and imaging procedures to track down the actual underlying disease such as cancer, cirrhosis, or heart failure.
