Fluid in the abdominal cavity (Ascites)

Ascites is a condition when there is fluid in the abdominal cavity (between the inner abdominal wall and the organs in the stomach). This condition is caused by several diseases, such as :

• Liver disease.
• Cancer.
• Kidney illness.
• Heart disease.

Cause.

Ascitic fluid is formed from transudative fluid and exudative fluid. The two types of fluids contain different levels of protein.

• Transudative fluid : has a protein content < 2.5 g / mL.
• Exudative fluid : has a protein content of ≥ 2.5 g / mL.

To determine the cause of ascites, division according to the serum-ascites albumin gradient (SAAG). The causes of ascites are divided into :

• Portal hypertension increased blood pressure in the blood vessels leading to the liver (portal vein system). 

Portal hypertension can be caused by :

• Liver disease.
• Cirrhosis.
• Heart cancer.
• Heart.
• Heart valve disease that separates the right ventricle of the heart from the right atrium (tricuspid valve).
• Pericarditis.
• Budd-Chiari Syndrome.
• Portal vein thrombosis ➡ blood clotting in the portal vein system.

Other conditions that can cause ascites to form :

• Low albumin protein due to nephrotic syndrome or malnutrition.
• Diseases of the lining of the stomach wall (peritoneum), such as peritonitis, peritoneal cancer and vasculitis.
• Pancreas, bile, kidney, ovary disorders.
• Lupus disease.
• Myxedema : low thyroid hormone in the blood.

Symptoms.

Patients with mild ascites usually do not experience any symptoms. Symptoms that sufferers will feel :

• Bloated and enlarged stomach.
• Weight gain.
• Abdominal pain.
• Hard to breath.
• Decreased appetite.
• Nausea and vomiting.
• Constipation.
• Heartburn.
• Swelling in the legs and ankles.

Go to the hospital immediately if you have the following symptoms :

• Fever.
• Abdominal pain.
• Vomits blood or is black in color.
• The stool is black or bloody.
• Bruising easily.
• Hard to breath.
• Yellow skin and eyes.
• Decreased consciousness.

Diagnosis.

• Physical examination, symptoms and medical history of the patient.
• Abdominal examination to check the fluid in the abdominal cavity by pressing on the patient's stomach.
• CT scan and MRI.
• Blood test.
• Check the function of the liver and kidneys.
• Measure electrolyte and protein levels.
• Angiography.
• Laparoscopy.
• Ascitic fluid analysis.
• Laboratory tests to determine blood cell counts, albumin levels, amylase enzymes, protein and glucose.
• Examination of ascitic fluid to determine the presence or absence of cancer cells (cytology) or the growth of certain bacteria (culture).

Treatment.

• Treatment of diseases that cause ascites.
• To reduce the amount of ascitic fluid, your doctor will give you a diuretic (a combination of furosemide and spironolactone), which will increase the discharge of body fluids through the kidneys.
• Reducing salt and fluid consumption.
• Increase consumption of protein or provide albumin supplements.
• Antibiotics if infection is present.
• If the drugs do not work, paracentesis or ascites punctures will be performed to remove fluids.
• Patients with portal hypertension will undergo transjugular intrahepatic portosystemic shunts (TIPS). This operation is done to create a new blood vessel (shunt) that connects the portal vein to the hepatic vein, which is the blood vessel that leaves the liver, without first passing through the liver cells.
• If ascites is caused by cirrhosis, a liver transplant will be performed.

Complications.

• Spontaneous Bacterial Peritonitis (SBP).
• Infection of the abdominal cavity.
• Hepatorenal syndrome.
• Kidney illness.
• Malnutrition and weight loss.
• Hard to breath.
• Hepatic encephalopathy : decreased liver function in detoxifying toxins, so toxins accumulate in the brain.

Prevention.

Ascites can be prevented by avoiding risk factors for diseases that cause ascites.