The Swollen Belly: Ascites

When fluid accumulates in the belly area, this is known as ascites. Common in people with cirrhosis— a chronic liver disease— ascites may also occur in people with conditions such as heart failure, kidney failure, infection, or cancer. Ascites tends to develop when the liver is starting to fail, and it is usually a sign of advanced liver disease.¹ Fluid accumulation in the belly can cause the stomach area to become very large and swollen looking, which can lead to shortness of breath or loss of appetite.²

What is the connection between ascites and hepatitis C?

Hepatitis can cause serious damage to the liver. For people with chronic hepatitis C infection, cirrhosis can develop if the symptoms remain untreated and the hepatitis infection continues to progress. Alcohol use and some medications can also increase the risk for ascites in patients with hepatitis C, as these can be additionally damaging to the liver.³

What causes ascites?

For patients with hepatitis C, the primary cause of ascites is cirrhosis. When the damage to the liver has reached the point of cirrhosis, the blood begins to flow more slowly through the liver. Blood pressure can then increase in the vein that brings blood from the intestines to the spleen or liver. This is called portal hypertension. Portal hypertension can lead to the fluid accumulation in the belly known as ascites. Ascites can also occur with cirrhosis if the liver becomes unable to make enough of certain necessary blood proteins.⁴

What are the symptoms?

Most patients with ascites will experience an enlargement or swelling in the belly, along with rapid weight gain. Other symptoms can include:¹

• Pain or discomfort in the swollen area
• Trouble breathing
• Infection
• Hernia
• Fluid buildup in the chest

How is ascites diagnosed?

Sometimes, ascites can be diagnosed in the doctor’s office with a physical examination. To confirm a diagnosis, a physician may run certain tests, such as an ultrasound or CT scan of the belly. A test to examine the fluid may be conducted. In these cases, after a local anesthetic is applied, the doctor will insert a small needle into the belly to extract the fluid. The doctor can then test this fluid to determine its cause.¹

Is it dangerous?

Undiagnosed or untreated, ascites can lead to complications, including:⁵

• Limited mobility from severe abdominal pain
• Infection cause from bacteria growing in the fluid swelling the belly
• Fluid in the lungs, also known as hepatic hydrothorax
• Kidney failure

If ascites has developed, this is an indication that a patient is in a state of advanced liver disease. Surgery may be required to relieve the portal hypertension. In severe cases, a liver transplant may be needed.^1,5

What are my treatment options?

Reducing salt intake is usually the first step to treating and managing the symptoms of ascites. This may require a change of diet. Some doctors may also recommend diuretics, or water pills, to treat ascites. If neither of these options reduce the fluid buildup in the belly, this fluid may need to be removed through a medical procedure called paracentesis.⁵

How can I prevent ascites?

If you have been diagnosed with hepatitis C, it is crucial that you get medical treatment. To prevent the development of ascites, you may want to also consider paying attention to any weight gain, and notify your doctor if you gain more than 10 pounds in a short period of time. In addition, limit or eliminate alcohol consumption and consider a low-salt diet. Limiting the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, may also reduce the risk of water and salt retention in the body, and therefore may help prevent the development of ascites.⁵