The build-up of fluid in ascites is caused by restricted flow of blood through the liver due to scar tissue in the liver, which in turn increases pressure in the veins. In addition, the damaged liver produces less of a protein called albumin, which regulates the distribution of fluid in the body. This imbalance combined with the increased pressure means that fluid escapes from vessels into the abdomen.¹
Symptoms of ascites
At the beginning, the water retention in early ascites may not be noticeable and might not cause any discomfort. However, as ascites progresses, the abdominal circumference increases as the volume of fluid increases. This can cause discomfort, nausea, loss of appetite and shortness of breath.1,2
When should you contact a healthcare professional?
If you have ascites and have abdominal pain and/or a fever, you should contact a healthcare professional immediately as these can be symptoms of spontaneous bacterial peritonitis (SBP). This is a potentially life-threatening complication of ascites caused by an infection in the tissue lining the abdomen and requires treatment with antibiotics.1,3
How is ascites treated?
Treatment of ascites aims to reduce the amount of fluid in the abdominal cavity. This can be achieved by helping the kidneys to remove water and salt with medicines called diuretics, through dietary changes to reduce salt intake and with paracentesis (a procedure to drain the fluid).1
Dietary changes to reduce salt intake include avoiding adding salt to food and avoiding pre-prepared foods. Referral to a dietitian for further guidance and advice can be helpful, as it can be difficult to adjust to a low salt diet.1
Paracentesis is used to drain abdominal fluid in people with moderate to large volumes of ascites. A needle is inserted into the abdomen under local anesthesia, and the fluid is removed. Removing such a large volume of fluid can cause stress on the circulatory system, and as such, a concentrated protein solution is administered at the same time to manage this.1
Life expectancy with ascites
The development of ascites means that the cirrhosis of the liver is progressing, and life expectancy is estimated to be 50% in 2 years. Treatment at this stage of the disease is focused more on relief of symptoms, based on individual goals and the burden of the disease.4
The development of ascites means that the cirrhosis of the liver is progressing.
- Nursing Times. Management of ascites in patients with liver disease. Available at: https://www.nursingtimes.net/clinical-archive/long-term-conditions/management-of-ascites-in-patients-with-liver-disease-18-09-2018/ (Last accessed: August 2020)
- British Liver Trust. What is ascites. Available at: https://britishlivertrust.org.uk/what-is-ascites/ (Last accessed: August 2020)
- Biecker E, World J Gastroenterol. 2011;17(10):1237-1248
- Perri GA, Can Fam Physician. 2013;59(12):1297-1299
May 2021. GL-HEP-XIF-2000181