Pathophysiology of ascites is directly connected to other critical conditions since it is usually their complication rather than a separate diagnosis. This health issue is frequently related to cirrhosis since 50% of the patients with this issue tend to develop it (Chiejuna et al., 2020). It implies the accumulation of fluid in one’s peritoneal cavity, which significantly increases the risks of bacterial peritonitis and hepatorenal syndrome and, consequently, the mortality rates (Chiejuna et al., 2020). This health issue is graded by its severity from 1 (mild form) to 3 (severe form) and appears after variceal bleeding (Rudler et al., 2020). In addition, the pathophysiology of ascites is explained by the processes accompanying the development of cirrhosis, which primarily include “the reorganization of the hepatic structure” and “an increase in hydrostatic pressure in the sinusoid capillaries” (Rudler et al., 2020, p. 129). These problems are followed by other complications, which increase the risks of a lethal outcome in the affected persons from “spontaneous bacterial peritonitis and hepatorenal syndrome” (Rudler et al., 2020; Chiejuna et al., 2020). Hence, ascites is one of the alarming states following other diseases’ emergence.
Diagnosis: Tests/Studies
Physical examination (evident at a volume of more than 1.5); Diagnostic abdominal paracentesis; Appropriate ascitic fluid analysis; Tests on a blood cell count (a total nucleated cell count and polymorphonuclear neutrophils (PMN) count); A bacterial culture (bedside inoculation of blood culture bottles); Measuring ascitic fluid protein; Measuring albumin; Measuring the serum albumin level; Calculating the serum-ascites albumin gradient (SAAG); Additional tests required if a diagnosis is suspected clinically; LDH and glucose level (Lactate dehydrogenase); Helps determine secondary peritonitis; Other options: amylase; Mycobacterial culture when tuberculosis is suspected; Chest x-ray, ultrasound, CT scan (detect the presence of any masses) (Chiejina et al., 2020).
Management/Treatment: Consequences of Cirrhosis The appropriate interventions in the case if ascites is confirmed to be the complication of cirrhosis should be performed in a timely manner. In this case, they are intended for the treatment of the underlying liver disease and hepatitis B, and one of the requirements is alcohol cessation (Tsochatzis & Gerbes, 2018). In addition, the task in this respect relates not only to addressing the interconnected diseases but determining the methods of assistance, which should be rejected once a new issue is reported. In general, they include the adoption of angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatories, and aminoglycosides because they can worsen the condition of patients with ascites (Tsochatzis & Gerbes, 2018). The continuation of rendering medical services implies moderate sodium restriction, the use of diuretics, spironolactone monotherapy, furosemide, and urinary electrolytes (Tsochatzis & Gerbes, 2018). Meanwhile, monitoring the situation is critical for detecting a further worsening presented by acute kidney injury, encephalopathy, electrolyte disorders, and many other problems (Tsochatzis & Gerbes, 2018). Thus, the care for the patients with ascites should comply with the above principles.
Risk Factors
Underlying liver disease/liver insufficiency (Rudler et al., 2020); Portal hypertension; Chronic alcohol use; IV drug use; Obesity; Hypercholesterolemia; Type 2 diabetes; Nephrotic syndrome; Severe malnutrition; Pancreatic ascites; Ovarian lesions (Chiejuna et al., 2020).
Symptoms
- Progressive abdominal distension;
- Abdominal discomfort;
- Weight gain;
- Early satiety;
- Shortness of breath;
- Dyspnea resulting from fluid accumulation;
- Increased abdominal pressure;
- Fever (in spontaneous bacterial peritonitis);
- Abdominal tenderness (in spontaneous bacterial peritonitis);
- Confusion (in spontaneous bacterial peritonitis) (Chiejuna et al., 2020).
Other Interventions
Other options for treating this disease depend on the severity of one’s condition and are based on the consideration of personal characteristics. Thus, the emergence of refractory ascites, which are the recurring events after the end of the therapeutic interventions, is addressed by liver transplantation (Tsochatzis & Gerbes, 2018). In turn, large-volume paracentesis or, in other words, removing the fluids usually precedes this operation (Tsochatzis & Gerbes, 2018). Albumin is applied to reduce mortality among people with this complication, and it is complemented by the placement of a transjugular intrahepatic portosystemic shunt (TIPS) (Rudler et al., 2020). The latter method contributes to relief in ascites and might also help avoid paracentesis for some patients (Rudler et al., 2020). In this case, if the affected persons develop spontaneous bacterial peritonitis, their treatment is based on the prescription of antibiotics and to prevent the spreading of various infections (Rudler et al., 2020). In this way, an individualized approach to curing ascites is required for a positive outcome in the long run and helps eliminate the risks of similar health issues in the future.
References
Chiejina, M., Kudaravalli, P., & Samant, H. (2020). Ascites. StatPearls.
Rudler, M., Mallet, M., Sultanik, P., Bouzbib, C., & Thabut, D. (2020). Optimal management of ascites. Liver International, 40, 128-135.
Tsochatzis, E. A., & Gerbes, A. L. (2017). Diagnosis and treatment of ascites. Journal of Hepatology, 67(1), 184-185.