Information Leaflet
Irish National Liver Transplant Unit
Ascites
What is ascites?
Ascites is a build up of fluid in the abdominal cavity which occurs slowly over a period of
weeks or months. It tends to occur in long standing (chronic) rather than short lived (acute)
conditions. It occurs more commonly when the liver is badly scarred (known as cirrhosis)
and is associated with many liver diseases. It is usually accompanied by other signs and
symptoms of liver disease. Ascites is always a sign of serious disease and should be reported
to your doctor. Ascites that does not respond to treatment may be an indication for Liver
Transplantation.
What causes ascites?
In liver disease ascitic fluid leaks from the surface of the liver and intestine. There are a
number of factors responsible for causing ascites.
1.
A fall in the production of albumin (protein) by the liver.
Albumin helps to regulate the fluid level in the body and prevents the fluid part of the
blood leaking into the body’s tissues. If the albumin levels are low this regulatory
function is impaired.
2.
Portal Hypertension.
Due to cirrhosis of the liver there is back pressure in the blood supply system to the
liver which causes a rise in pressure in the small blood vessels and leads to ascites
formation.
3.
Retention of fluid by the kidneys –
due to the retention of salt in the body.
4.
Alterations in various hormones and chemicals –
that regulates bodily fluids.
What are the signs and symptoms of ascites?
A small amount of fluid in the abdomen usually doesn’t cause any symptoms. A large build
up of fluid will cause:
1.
Increase in weight.
2.
3.
4.
5.
6.
The abdomen to become swollen. The individual may notice their waist size has
increased.
Large amounts of ascites causes the abdomen to become taut and the umbilicus may
become falttened or pushed out.
Large volumes of ascites may cause pain and discomfort in the abdomen. It may also
cause difficulties with eating and breathing.
Shortness of breath may be experienced when the amount of ascites exceeds 3 litres.
This is caused by the diaphragm (muscle layer between the chest and abdomen) being
pushed up into the chest cavity or a build up of fluid on the lung (pleural effusion).
The appearance of prominent veins under the skin of the abdomen.
How is it diagnosed?
1.
2.
3.
4.
5.
Increase in weight.
A large swollen abdomen.
Physical examination by the doctor.
A sample of fluid may be removed from the abdomen using a syringe and needle and
is analysed. This is called a diagnostic paracentesis.
Abdominal ultrasound.
How is ascites treated?
There are various treatments available to reduce ascites. Treatment can be carried out at
home, or in hospital, or a combination of both, may occur depending on the severity of the
ascites.
1.
2.
3.
4.
5.
Low salt diet. The dietician will advise you re same.
Diuretics (water tablets). Spironolactone (aldactone) is the most common diuretic
used but there are other types available. Diuretics work by making the kidneys pass
extra volumes of water. Diuretics can affect the kidney’s ability to function and can
effect the individual’s sodium level (blood salt levels). The dose of diuretic is
influenced by (a) weight loss – optimal loss is up to 0.5 kgs per day. Weight will be
recorded daily while in hospital, (b) sodium levels, (blood salt levels) and (c) Kidney
function. Sodium levels and kidney functions are monitored by blood tests which are
carried out daily as an in-patient and at regular intervals as an out-patient.
paracentesis. If diuretics cannot be used or the volume of ascites is making the
individual very uncomfortable, a paracentesis may be carried out. This involves
draining the fluid in your abdomen using a syringe and needle. paracentesis on it’s
own is only a temporary measure in controlling ascites as the fluid tends to reaccumulate. Large amounts of albumin are lost from the blood into the ascites.
Albumin may be administered via a drip during or after paracentesis.
Rarely required - A fluid restriction of 1.5 litres or less may be necessary depending
on the severity of the ascites and sodium levels (blood salt levels).
If your ankles are swollen, elevate your lower limbs when at rest.
Resistant Ascites
Ascites that does not respond to above treatments is called resistant ascites. Resistant ascites
is treated by a non-surgical shunt called TIPS or a surgical shunt.
Spontaneous Bacterial Peritonitis (S.B.P.)
Ascitic fluid may become infected by bacteria. Indicators of infection are: unexplained
temperatures, pain and tenderness in the abdomen and encephalopathy (confusion). These
symptoms should be reported to the Liver Unit Registrar as you may need to be admitted to
hospital for treatment. The bacteria causing the infection will be identified by a diagnostic
paracentesis. The infection will be treated with intravenous antibiotics.