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Ascites

What is ascites?

Ascites is excess fluid in your lower abdomen. The fluid causes swelling. Ascites can signal a more serious problem in your body.

What causes ascites?

  • Liver disease, such as cirrhosis or hepatitis

  • Cancer

  • Congestive heart failure

  • Blood clots in the veins that enter and leave the liver

What are the signs and symptoms of ascites?

  • Rapid weight gain and swelling

  • Swollen abdomen

  • Shortness of breath

  • Stretch marks and bulging veins on the abdomen

  • Nausea

  • A feeling of fullness after eating little food

How is ascites diagnosed?

Your caregiver will ask you to lie on your back while he taps or presses on your abdomen. He will ask about your symptoms and when they started. He will ask about alcohol or IV (intravenous) drug use, sexual activity, and any blood transfusions you have had. Tell him if you have had heart problems or cancer.

  • Blood and urine tests: Caregivers will test samples of your blood and urine 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: You will use a container to hold all of your urine collected over 24 hours. The urine must be kept cold until it is tested.

  • Other tests: 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.

How is ascites treated?

Ascites treatment usually combines medicines with changes to your eating and drinking habits. Other treatments are used if your ascites does not improve or if the condition that caused the ascites is getting worse.

  • 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. Ask your caregiver how much weight you should expect to lose each day.

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

    • Vaccines or 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 ask you to 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 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 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.

What are the risks of ascites?

  • 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.

How do I manage ascites?

  • Do not drink alcohol: Alcohol worsens the damage to your liver. Your ascites may improve or even go away after you stop drinking. Do not take medicines that contain alcohol. Ask your caregiver for information if you need help to quit drinking alcohol.

  • Follow your low-sodium plan: A dietitian can help you create a low-sodium diet. He may suggest lemon juice or herbs to flavor your food. Avoid salted butter or margarine, milk, cheese, and canned or frozen foods that are not made for low-salt diets. Ask your caregiver or dietitian before you use salt substitutes.

  • Write down your daily weight: You will need to track your weight at home so caregivers can see if treatment is working. Weigh yourself each day. Ask your caregiver how much weight you should be losing. Your caregiver will want to know if you are losing too much or too little weight.

  • Ask about NSAIDs: NSAIDs are over-the-counter pain and fever medicines. You may not urinate enough to take NSAIDs safely. Ask your caregiver if NSAIDs are safe for you. Follow directions carefully. These medicines can cause stomach bleeding or kidney problems if they are not taken correctly.

  • Limit activity: Too much physical activity may make your ascites worse. Ask your caregiver if you have any limits to your normal daily activities. Rarely, bedrest is needed if other health problems develop with ascites.

Where can I find more information?

  • American College of Gastroenterology
    6400 Goldsboro Rd., Ste 450
    Bethesda , MD 20817
    Phone: 1- 301 - 263-9000
    Web Address: http://www.gi.org

When should I contact my caregiver?

Contact your caregiver if:

  • You are losing more or less weight than expected.

  • You are urinating less than usual.

  • You feel dizzy or lightheaded.

  • You develop tiredness, dry mouth, nausea, or vomiting.

  • You have muscle cramps or twitches.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You have a fever.

  • You feel pain in your abdomen.

  • You have trouble breathing.

  • You feel confused, faint, or lose consciousness.

  • You vomit blood or see blood in your bowel movement.

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. 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.

© 2014 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.

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