Ascites

Definition

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

Alternative Names

Portal hypertension - ascites; Cirrhosis - ascites; Liver failure - ascites; Alcohol use - ascites; End-stage liver disease - ascites; ESLD - ascites; Pancreatitis ascites

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:

People with certain cancers in the abdomen may develop ascites. These include cancer of the appendix, 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, This happens because the fluid pushes up on the diaphragm, which in turn compresses the lower lungs.

Many other symptoms of liver failure may also be present.

Exams and Tests

Your doctor will do a physical exam to determine if the swelling is likely due to fluid buildup 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 and to check if the fluid is infected.

Treatment

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

Treatments for fluid build-up may include lifestyle changes:

You may also get medicines from your doctor, including:

Other things you can do to help take care of your liver disease are:

Procedures that you may have are:

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

If you have cirrhosis, avoid taking nonsteroidal anti-inflammatory medicines, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Acetaminophen should be taken in reduced doses.

Possible Complications

Complications may include:

When to Contact a Medical Professional

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

References

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 144.

National Institute of Diabetes and Digestive and Kidney Diseases website. Cirrhosis. www.niddk.nih.gov/health-information/liver-disease/cirrhosis/all-content. Updated March 2018. Accessed November 11, 2020.

Sola E, Gines SP. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 93.


Review Date: 7/15/2020
Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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