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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Ascites

Portal hypertension - ascites

Last reviewed: October 13, 2013.

Ascites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs.

Causes

Ascites results from high pressure in the blood vessels of the liver (portal hypertension) and low levels of a protein called albumin.

Diseases that can cause severe liver damage can lead to ascites. These include long-term hepatitis C or B infection and alcohol abuse over many years.

People with certain cancers in the abdomen may develop ascites. These include cancer of the colon, ovaries, uterus, pancreas, and liver.

Other conditions that can cause this problem include:

Kidney dialysis may also be linked to ascites.

Symptoms

Symptoms may develop slowly or suddenly depending on the cause of ascites. You may have no symptoms if there is only a small amount of fluid in the belly.

As more fluid collects, you may have abdominal pain and bloating. Large amounts of fluid can cause shortness of breath.

Many other symptoms of liver failure may also be present.

Exams and Tests

Your doctor will do a physical exam to determine the amount of swelling in your belly.

You may also have the following tests to assess your liver and kidneys:

Your doctor may also use a thin needle to withdraw ascites fluid from your belly. The fluid is tested to look for the cause of ascites.

Treatment

The condition that causes ascites will be treated, if possible.

Treatments for fluid build-up may include lifestyle changes:

  • Avoiding alcohol
  • Lowering salt in your diet (no more than 1,500 mg/day of sodium)
  • Limiting fluid intake

You may also get medicines from your doctor including:

  • "Water pills" (diuretics) to get rid of extra fluid
  • Antibiotics for infections

Procedures that you may have are:

  • Inserting a tube into the belly to remove large volumes of fluid (called a paracentesis)
  • Placing a special tube or shunt inside your belly (TIPS) to repair blood flow to the liver

People with end-stage liver disease may need a liver transplant.

Possible Complications

When to Contact a Medical Professional

If you have ascites, call your health care provider right away if you have:

  • Fever above 100.5F, or a fever that does not go away
  • Belly pain
  • Blood in your stool or black, tarry stools
  • Blood in your vomit
  • Bruising or bleeding that occurs more easily
  • Build-up of fluid in your belly
  • Swollen legs or ankles
  • Breathing problems
  • Confusion or problems staying awake
  • Yellow color in your skin and whites of your eyes (jaundice)

References

  1. Runyon BA. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 91.
  2. Runyon BA; AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: Update 2012. American Association for the Study of Liver Diseases. 2013. [PubMed: 19475696]
  3. Mehta G, Rothstein KD. Health maintenance issues in cirrhosis. Med Clin North Am. 2009;93:901-915. [PubMed: 19577121]
  4. Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 156.

Review Date: 10/13/2013.

Reviewed by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Patients with refractory ascites may temporarily benefit from transjugular intrahepatic portosystemic stent‐shuntsPatients with refractory ascites may temporarily benefit from transjugular intrahepatic portosystemic stent‐shunts
    Refractory ascites causes substantial morbidity in patients with cirrhosis. Randomised trials have compared transjugular intrahepatic portosystemic stent‐shunts with paracentesis. Mortality, gastrointestinal bleeding, renal failure, or infection did not differ significantly between the two intervention groups. Transjugular intrahepatic portosystemic stent‐shunts effectively decreased the risk of ascites fluid re‐accumulation, but was associated with an increased risk of hepatic encephalopathy.
See all (14) ...

Figures

  • Ascites with ovarian cancer, CT scan.
    Digestive system organs.

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