Ascites

WHAT YOU SHOULD KNOW:

Ascites (Inpatient Care) Care Guide

Ascites is excess fluid in the lower abdomen. The fluid causes swelling in the abdomen.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • The excess fluid may affect your ability to breathe. Your swollen abdomen can make it hard to eat. Hernias (weak areas in the muscles on your abdomen) may form from the pressure of the fluid. Treatment can change your electrolyte (body chemical) balance. Electrolyte changes can cause confusion, drowsiness, and thinking and movement problems that may lead to coma. You may get an infection called spontaneous bacterial peritonitis in your abdomen that can be life-threatening. You will need more medicines or treatments if you develop these problems.

  • Even with treatment, the condition that caused your ascites may become life-threatening. Bleeding in the esophagus or liver or kidney failure can occur.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Tests:

  • Neurological exam: This test is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain is working during your treatment. Caregivers will check how your pupils react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

  • Blood and urine tests: Caregivers will take samples of your blood and urine for tests to see how your liver and kidneys are working.

  • Abdominal ultrasound: Gel helps your caregiver move a sensor over your abdomen during an ultrasound. The sensor uses sound waves to show pictures of your organs on a monitor.

  • CT scan: A CT scan uses a computer to take x-rays of the organs and blood vessels in your abdomen. You may be given dye called contrast to help the pictures show up better. Tell the caregiver if you are allergic to iodine or seafood. You may also be allergic to the dye.

  • Ascites fluid test: Caregivers use a needle to take a sample of fluid from your abdomen for testing. This procedure is called a fluid tap or paracentesis. Numbing medicine makes you more comfortable during this test. Tests on the fluid help find the cause of your ascites and screen for infection.

  • 24-hour urine collection: Caregivers may need to collect all of your urine over 24 hours. The urine is placed in a container in your room that sits in ice. The urine must be kept cold until it is tested.

  • Tests to find the cause of your ascites: Tests such as endoscopy or laparoscopy use a scope (tube) with a camera on its tip to see your lower esophagus or liver. Anesthesia medicine will keep you numb or asleep during the procedure. Caregivers will look for bleeding or blood clots. A tissue sample (biopsy) may be taken. These tests help caregivers plan the best treatment for your ascites.

Monitoring:

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

  • Weight: You may be weighed each day. Caregivers compare your weight from day to day to record how much body fluid you have. You can become dehydrated if you lose too much. You can have shortness of breath or swelling in your legs if you retain too much.

  • Abdominal measuring: Caregivers use a measuring tape to measure around your abdomen. Your abdomen may be measured as often as every four to eight hours to see if it is getting smaller or larger.

Medicines:

  • Diuretics: Diuretics help decrease the fluid in your abdomen by causing you to urinate more often. You will lose weight as the fluid decreases.

  • Antibiotics: These medicines are used to prevent or fight infections caused by bacteria.

  • Vaccines and antiviral medicines: When ascites is caused by hepatitis (a virus that attacks your liver), antiviral medicines may help prevent more damage to your liver. Caregivers may give you vaccines to prevent hepatitis.

Sodium and liquid restriction:

  • Sodium: You must lower the amount of sodium (salt) you eat and drink to reduce the fluid in your abdomen. Sodium is in many foods, even when you cannot taste it. You may need to be on a 2-gram sodium diet, which limits your sodium to less than half a teaspoon each day. Ask your caregiver for more information about low-sodium diets.

  • Liquid: Caregivers may limit your liquids to about 34 ounces (about 2 pints) a day if you are not losing fluid with a low-sodium diet.

Procedures and surgeries:

  • Paracentesis: Your caregiver drains the extra fluid out of your abdomen through a needle. You will receive numbing medicine before the procedure. Paracentesis can quickly remove quarts of fluid. Paracentesis may be repeated if the ascites does not respond to other treatments.

  • Transjugular intrahepatic portosystemic shunt: This procedure is also called TIPS. TIPS can treat large ascites when you cannot have paracentesis. Your caregiver uses a catheter (plastic tube) to increase blood flow through your liver. This helps to reduce the fluid in your abdomen.

  • Liver transplant: Sometimes your liver is so damaged that a liver transplant is the only long-term treatment option.

  • Peritoneovenous shunt: This procedure drains the extra fluid into a large vein to be absorbed by the body. The shunt is a tube placed in your abdomen and connected to the vein. Caregivers may use this procedure if you cannot have a liver transplant or other ascites treatments.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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