Summary
Ascites is a condition characterized by the pathological accumulation of fluid in the abdominal cavity. A small amount of ascitic fluid is always present in the peritoneum cavity. This fluid is constantly moving into the lymphatic vessels and is replaced by a new one. However, with some disturbances in the body’s work, this fluid either begins to be produced in excess or ceases to be absorbed. As a consequence, it accumulates and begins to push on internal organs, worsening their functioning.
The pathogenesis of this condition remains the subject of close study for decades due to its complexity. Factors are sodium retention in kidneys, increased liver lymph production, splanchnic vasodilation due to nitric oxide, and Starling forces changes in the portal vessels (Tholey, 2021). They can be triggered by diseases such as cirrhosis, renal or heart failure, cancer, or infection. Symptoms include rapid weight gain, leg swelling, loss of appetite, heartburn, nausea, shortness of breath, vomiting, indigestion, high fever, and hernia (Nazario, 2020). The condition worsens the quality of life and can lead to complications such as kidney failure, increased risk of infections, and death.
Diagnosis
The physical examination can give grounds for establishing a diagnosis of ascites when detecting shifting dullness. However, ultrasonography or computed tomography (CT) as imaging tests are more accurate and can reveal small volumes of liquid that are not so noticeable during a physical examination (Tholey, 2021). In cases where the diagnosis has just been made and the cause of the condition is unknown, abdominal paracentesis is performed. The procedure involves removing about 50-100 milliliters of fluid from the abdomen using a needle for further analysis (Tholey, 2021). Experts check the appearance, cytology, protein content, number of cells, acid-fast stain, and other aspects. Finding out the cause is necessary since it is critical to curing the disease that caused ascites.
Differential diagnosis
- Acute Liver Failure
- Cirrhosis
- Primary Biliary Cholangitis (Primary Biliary Cirrhosis)
- Biliary Disease
- Hepatocellular Adenoma (Hepatic Adenoma)
- Familial Mediterranean Fever
- Viral Hepatitis
- Nephrotic Syndrome
- Protein-Losing Enteropathy
- Dilated Cardiomyopathy
- Restrictive Cardiomyopathy
- Budd-Chiari Syndrome
- Portal Hypertension (Shah, 2017).
Risk Factors
Abdominal ascites most often develop gradually over many months, and therefore most patients do not pay attention to it for a very long time. Any diseases that lead to liver damage, cirrhosis or scarring are risk factors for ascites. Such diseases include:
- Alcohol use disorder.
- Fatty liver disease, which is not related to alcohol.
- Autoimmune hepatitis.
- Hepatitis B.
- Hepatitis C.
Genetic liver diseases: Wilson disease, hemochromatosis, and other conditions.
Besides diseases damaging the liver, some other conditions are risk factors — renal and chronic heart failure, cancer, and infections.
Incidence
Ascites is not characteristic of healthy people but are a consequence of diseases. About 50% of patients with cirrhosis receive such a complication as ascites (Cleveland Clinic, 2021). At the same time, 80% of cases of ascites are a consequence of cirrhosis.
References
Cleveland Clinic. (2021).Ascites.
Nazario, B. (2020). Ascites. WebMD.
Shah, R. (2017). Ascites Differential Diagnoses. Medscape.
Tholey, D. (2021). Ascites. MSD Manuals.