Abdominal Dropsy - Ascites

Ascites is the abnormal accumulation of fluid within the abdominal cavity. It is a condition with a wide range of causes. Ascites develops most frequently as a result of liver disease. It can also be seen in people who have cancer, kidney disease, and heart disease. Ascites is seen in people with pancreatic disease, as well as other conditions.

What is going on in the body?

Mechanisms in the body leading to ascites are complex and not completely understood.

All of these events may lead to a large volume of abdominal ascites. Adults with cirrhosis of the liver may have as much as 10 to 12 liters of fluid in their abdominal cavities.

What are the causes and risks of the condition?

Ascites is most often a result of liver disease, including the following:

Other common causes of ascites include the following:

What are the signs and symptoms of the condition?

Depending on the amount of ascites and the cause, there may be no symptoms at all. Following are some of the common symptoms:

How is the condition diagnosed?

The diagnosis of ascites begins with a medical history and physical exam. The healthcare provider may be able to detect fluid in the abdomen. Special X-ray tests are also commonly used to diagnose ascites and help determine the cause.

A diagnostic test, called paracentesis, may be done. This involves the insertion of a needle through the skin and into the abdominal cavity. The needle is used to withdraw fluid. Testing the fluid helps to determine the cause of the ascites. For example, an elevated white blood cell count, or WBC, may indicate an infection.

What can be done to prevent the condition?

Some cases of ascites can be prevented. For example, cirrhosis can be prevented by drinking alcohol only in moderation. Effective treatment of congestive heart failure can prevent ascites from that cause.

What are the long-term effects of the condition?

Long-term effects of ascites can include the following:

What are the risks to others?

Ascites is not contagious and poses no risk to others.

What are the treatments for the condition?

Treatment of ascites includes treatment of the underlying disorder. Some of the general treatment guidelines followed for ascites itself are as follows:

Diuretics, also called water pills, may also be used to treat ascites. These medications help the body excrete extra water through the kidneys. Common diuretics include spironolactone, amiloride, and triamterene. If these are not effective, stronger diuretics may be used. These stronger medicines include furosemide, thiazide, and ethacrynic acid.

Some people with massive ascites may need a paracentesis to remove excess fluid. A needle is inserted into the abdominal cavity, and extra fluid is drained out.

Most people respond to these measures. About 10% to 15% are resistant and require other methods to control the ascites.

Other individuals may need a transjugular intrahepatic portosystemic shunt, also called TIPS. This is a mesh tube that is passed through the skin of the neck and into the jugular vein. The tube is then advanced into the liver. It is pushed into the portal vein, which drains into the liver. The shunt reduces pressure and ascites formation.

In rare and selected cases, a liver transplant may be needed.

What are the side effects of the treatments?

Side effects of diuretics can include the following:

Removal of large volumes of fluid using parencentesis may cause the following conditions:

Following are some of the side effects that shunting procedures can cause:

What happens after treatment for the condition?

In most cases, treatment of ascites is lifelong.

How is the condition monitored?

Ascites will be monitored with lab tests and regular visits to the healthcare provider. Any new or worsening symptoms should be reported to the provider.

Author:Susan Woods, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:05/31/01
Reviewer:Barbara Mallari, RN, BSN, PHN
Date Reviewed:09/24/01