What Is Ascites?
Ascites is simply the build-up of fluid within the abdomen, with the fluid filling the space between the lining of the abdominal wall and the organs found within the abdominal cavity. This space contains a membrane called the peritoneum. It usually holds very little fluid and is not meant to. However, when a disease, such as cirrhosis of the liver due to hepatitis C occurs, fluids can become built up in this space and cause stress to the body and be a sign of a more serious problem.
What causes ascites?
It is based on the combined experience of elevated blood pressure in the veins in the liver, which is called portal hypertension, at the same time that the liver is improperly functioning at a level that has resulted in significant scar tissue on the liver. This scarring is called cirrhosis. This typically occurs when the liver is not working properly and is most often occurring when the liver it beginning to completely fail. Ascites can be considered a sign by medical professionals that a patient is no longer benefiting from liver treatment protocols and may need to consider a liver transplant.
The symptoms of ascites are typically quite visible. The person is most likely to appear swollen in the stomach area or may even look pregnant, regardless of gender or age. In addition, wrists and ankles may begin to swell and the joints and muscles may be in pain due to the increase in overall patient weight. It may be difficult for some patients to breathe, as the fluid may be compressing the ability for the lungs to properly expand. This can feel very scary for a person and it can lead to experiences of panic or anxiety. At the same time, legs may become enlarged with fluid, breast areas may become enlarged (regardless of gender), and the patient may discover that they are bruising much easier than is typical for them. In any of these cases, it is important to document symptoms for medical professionals and to also seek immediate attention if the physical struggle to breathe or the emotional symptoms of panic or anxiety are causing significant concerns to the patient.
In some cases, the patient will get an infection, which can result in spontaneous bacterial peritonitis. This can lead to abdominal tenderness and pain, nausea, and fever. If this is not treated right away, the patient can have a severe enough infection that it can enter the blood stream and cause long-term damage. In order to know whether the patient has an infection, the fluid in the abdomen may be tested via a sample taken through a needle. In these cases, antibiotics can be effective if administered early enough in the infection, but patients will need a long term treatment plan to prevent reoccurrence.
Risk for infection and hernias
In addition, hernias are possible at this time. This is because the additional abdominal pressure from the fluid where it does not belong can cause hernias around the belly button (called umbilical hernias) or the groin (called inguinal hernias). These require surgical repair in the worst cases but may simply resolve themselves in more general cases. Only a doctor can properly diagnose whether a hernia will self-resolve or whether surgery or other treatments are a better way to address the concern. In surgical cases, the treating physicians are likely to specialize in surgeries involving patients with cirrhosis.
What should I do if I have ascites?
If you have ascites, your doctor may choose to simply monitor you to see whether the fluid amount is able to be handled by your body or if you need medical intervention. You may be prescribed a diet that is lower in sodium, in hopes of preventing fluid retention through food and beverage consumption. Diuretics may also be prescribed. Specific exercises may be required where the weight of the fluid is not a factor, such as water aerobics or other low-impact options. In addition, doctors may give you a list of factors to watch, in order to prevent ascites from becoming unmanageable and to know when to seek out medical treatment versus when not to worry. For example, doctors may require regular weight monitoring, with either regular reporting to their office or by telling the patient to go to the emergency room if the weight gain exceeds two pounds per day or totaling over ten pounds. These guidelines can help to limit the emotional stress and fear within a patient while also keeping the patient aware of when to seek treatment, before the situation can become too significant to be treated.1-6