OVERVIEW OF ASCITES
Ascites is a condition that results when greater than 25 milliliters (25mLs) of fluid accumulates in the abdomen. It happens when the liver does not function appropriately. When the liver does not function properly, fluid accumulates in the opening found between the lining of the abdomen and organs. The two-year survival rate of ascites is 50 percent as seen in the 2010 clinical guidelines published in the Journal of Hepatology. Ensure that you speak with a doctor if you experience symptoms of ascites.
CAUSES OF ASCITES
Ascites is commonly caused by cirrhosis, a form of liver scarring. This scarring leads to a pressure build-up inside the blood vessels of the liver. This pressure build-up can lead to leakage of fluid inside the abdominal cavity thus causing the anomaly.
RISK FACTORS FOR ASCITES
The major risk factor for liver cirrhosis is liver damage. The commonest causes of liver damage include:
- Cirrhosis
- Hepatitis B or C
- History of excessive alcohol intake
Other factors that increase the likelihood of developing this condition include:
- Cancer of the ovaries, pancreas, liver or the inner lining of the uterus
- Heart failure or kidney failure
- Inflammation of the pancreas
- Tuberculosis
- Hypothyroidism
WHEN SHOULD YOU SPEAK TO A DOCTOR
Depending on the cause of the ascites, the symptoms can develop insidiously or suddenly.
When the symptoms appear, they don’t necessarily mean that it is an emergency though you should talk to your doctor if you experience any of the following symptoms:
- Enlarged abdominal size
- A sudden increase in weight
- Shortness of breath on lying down
- Loss of appetite
- Abdominal pain
- Bloating and flatulence
- Nausea and vomiting
- Heartburn
These symptoms are general symptoms and can be caused by other health conditions.
MAKING A DIAGNOSIS OF ASCITES
After taking a concise history of the condition, the doctor will proceed to examine the abdomen to check for any swelling and also to elicit the presence of the condition by conducting special examinations such as fluid thrill.
Additional tests used to check for fluid in the abdomen include:
- Ultrasound scan
- CT scan
- MRI
- Blood tests
- Laparoscopy
- Angiography
TREATMENT OF ASCITES
The particular treatment modality for ascites will depend on the cause of the ascites.
DRUGS
The medical therapy for ascites is by the administration of Diuretics. The mechanism of action of diuretics is by increasing the amount of water and salts that exit the body thereby reducing the pressure inside the veins that surround the liver.
The blood chemistry should also be checked when the patient is on the diuretic. You may have to decrease your alcohol and salt intake to decrease the risk of developing ascites.
PARACENTESIS
It is a procedure that is done to remove extra fluid from the abdomen by inserting a long needle into the abdomen through the skin. Antibiotics should be prescribed prior to the procedure because there is a very high risk of infection so it helps to reduce the likelihood of infection.
This treatment modality is used for severe cases of ascites, recurrent ascites and for late stages of ascites where diuretics may not be very beneficial.
SURGERY
For extremely severe cases, blood circulation around the liver is rerouted by inserting a permanent shunt into the body. If all these modalities do not work, a liver transplant may be advised especially for those with end-stage liver failure.
COMPLICATIONS OF ASCITES
The common complications associated with ascites include:
- Abdominal pain
- Pleural effusion, this is an accumulation of fluid in the space between the lungs. This results in shortness of breath
- Hernias, due to the increased pressure
- Bacterial infections e.g. spontaneous bacterial peritonitis
- Hepato-renal syndrome, a form of kidney failure with liver affectation
KEYPOINTS
Ascites cannot be prevented but it can be managed. The risk of developing it can also be reduced by taking care of the liver. Do the following:
- Taper down your alcohol intake. Drink it occasionally as this will help to prevent cirrhosis
- Be vaccinated for hepatitis B
- Practice safe sex by using a condom as hepatitis can also be sexually transmitted
- Do not share sharps as hepatitis is also blood-borne
- Be aware of the side effects of your medications. If the liver is likely damaged, speak to the doctor about having a liver function test.
Tonika Bruce, DNP, MSN, RN, MBA is an accomplished nurse leader, published author, and personal development expert passionate about advancing healthcare management and quality patient outcomes.
She taps into the years of experience in healthcare management to produce credible and easy-to-understand health and leadership content. Her exceptional work has been featured in reputable publications, including Forbes, Recruiter, Inc, and the Color of Wellness magazine.
