How to Manage Ascites In Patients With Cirrhosis

What is ascites?

Ascites is the accumulation of fluid within the abdominal or peritoneal cavity. The fluid is typically serous fluid, which looks clear or very pale yellow. Ascites can exist in only one part of the abdomen or there can be multiple locations of fluid buildup at the same time.

There are two types of ascites, transudative and exudative, which are determined by how much protein is found in the fluid. This protein, called albumin, led to a grading scale called the Serum Ascites Albumin Gradient (SAAG).

How does a person get ascites? What does ascites have to do with hepatitis C?

There can be many reasons why a person gets ascites, including different types of cancers, congestive heart failure, kidney failure, or liver issues such as liver disease or cirrhosis. People who have hepatitis C or who have had hepatitis C are at risk for ascites because of the damage that the hepatitis C virus can do to their liver. A person whose liver is damaged becomes a person whose liver may be susceptible to ascites.

Although the exact science of why ascites develop is not fully understood, many medical theories suggest that the main contributor to ascites is portal hypertension. This is when the blood flow to the liver has increased pressure. This is considered to be similar to edema of the body in general, in which the body’s circulation pressure becomes imbalanced.

Other medical theorists believe that ascites form not just because of portal hypertension but that there has to also be an accompanying decrease in the blood protein albumin.

Doctors told me I have a high risk of ascites, what can I do to prevent it?

If your doctor tells you that you are a high risk patient, it is important to ask follow up questions to make sure you fully understand why your doctor has said this. Your doctor may provide you with pamphlets to further explain the information being told to you, and they may refer you to another medical professional for follow-up information or guidance.

Many people are considered to be at high risk of ascites because of their dietary behaviors. This is because some researchers believe that ascites may be contributed to by salt intake and water retention. When a person’s diet is high in salt, their body often responds by holding onto higher amounts of water. This can lead to overall edema and/or to ascites. If your diet is high in salt, your kidneys may think your blood volume is low, which can signal to the body to retain fluid and lead to the formation of ascites.

Your doctor may also consider you to be high risk if you are already struggling with fluid retention due to edema, cancer, or congestive heart failure. When the body is already holding on to extra fluids, it is much more likely to do so throughout the body, including within the abdomen.

How do I know if I have ascites?

Mild ascites often cause no symptoms at all. This is because mild ascites typically only contain less than 400ml of fluid. However, as more fluid amasses, the likelihood of symptoms increases. These symptoms typically include visual signs of fluid such as increased abdominal size either due to the fluid or to bloating, as well as abdominal discomfort or pain. In some cases, patients with ascites can experience shortness of breath or an unattractively large abdomen due to the fluid retention becoming severe enough to press on the lungs or for the fluid to push outward due to lack of space internally. Doctors can often diagnose ascites based on risk factors, symptoms, and sometimes through an external abdominal exam.

I have ascites, what do I do now?

Your doctor’s examination, as well as any ordered tests, will allow the doctor to determine the cause of your ascites. This will then allow the doctor to understand how to best treat you, as different causes equal different treatment methods.

In most cases, dietary alterations will be recommended. This typically includes significantly decreasing your salt intake via foods and beverages. In some cases, doctors will also prescribe diuretics (also known as water pills), which can help the body to flush out unnecessary fluids. In some cases, these pills will begin at a small dosage level and increase as needed, allowing the body to adjust to them and to continue to process out the extra fluids.

If you are prescribed diuretics, you may wish to take them in the morning, as taking them before bed can lead to sleep disturbances due to the need for frequent bathroom visits. In some cases, the amount of fluid retained cannot be removed using diet and diuretics. In these circumstances, the doctor may need to do a therapeutic paracentesis. This is when a doctor carefully inserts a needle into the abdomen to remove the fluid. For those with significant amounts of fluid, this may be suggested as a quicker way to minimize the amount of excess fluid in the body than to wait for diuretics to work.

In rare cases, surgery or a liver transplant may be required to remove the ascites from the body. Each body and each ascites are different. Although there is a great amount of research available through the internet and medical pamphlets, only your doctor can help you to understand your specific circumstances and guide you to the best medical decisions for your medical history and your body’s needs.1-6

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