1. What is ascites and
what causes it?
When fluid accumulates in the abdominal cavity, it is called ascites.
Cirrhosis of the liver is the most common cause of ascites but other
conditions such as heart failure, kidney failure, infection or cancer
can also cause ascites.
2. How common is ascites in people with cirrhosis?
Ascites is common in people with cirrhosis and it usually develops when
the liver is starting to fail. In general, the development of ascites
indicates evidence of advanced liver disease and patients should be
referred for consideration of liver transplantation.
3. What causes ascites in patients with cirrhosis?
Ascites is caused by a combination of elevated pressure in the veins
running through the liver (portal hypertension) and a decrease in liver
function caused by scarring of the liver.
4. What are the symptoms of ascites?
Most patients who develop ascites notice abdominal distension and rapid
weight gain. Some people also develop swelling of ankles and shortness
5. How is ascites diagnosed?
Depending on how much fluid is present in the abdomen, ascites may be
diagnosed by your doctor on physical examination but is usually
confirmed by tests such as ultrasound or CT scan of the abdomen. In the
majority of patients, your doctor will recommend that a small needle be
inserted through the abdominal wall (after local anesthesia) to remove
fluid to be examined in the laboratory. This test is called a
paracentesis. The fluid removed will be examined for signs of infection
or cancer and to determine the cause for the fluid accumulation.
6. Is ascites a dangerous sign?
Yes. The development of ascites generally suggests that the liver is not
working well. The survival rate 5 years after ascites develops is only
30-40% and it is important that you and your doctor discuss a referral
to a liver specialist and a liver transplant center.
7. What are the complications of ascites?
Abdominal pain, discomfort and difficulty breathing: These may occur
when too much fluid accumulates in the abdominal cavity. This may limit
your ability to eat, ambulate and perform activities of daily living.
Infection: This is called spontaneous bacterial peritonitis (SBP) and it
usually causes abdominal pain, tenderness, fever or nausea. If this is
not promptly diagnosed or treated, a patient may develop kidney failure,
severe infection in the blood stream or mental confusion. The diagnosis
is generally made by taking a sample of the fluid from your abdominal
cavity as described above. This infection can be treated with
intravenous antibiotics, and after recovery, patients will require long
term treatment with antibiotics to prevent SBP from recurring.
Ascites related hernias: Elevated intra-abdominal pressure can lead to
the development of umbilical (around the bellybutton) and inguinal
(groin) hernias that can cause abdominal discomfort. Surgical repair is
generally avoided unless there is severe pain suggesting the intestines
or tissue may be pinched or twisted along with a persistent bulge from
the hernia. Surgeons who have experience in treating patients with
cirrhosis should perform the operation.
Fluid may get into the chest: This is called hepatic hydrothorax and
abdominal fluid fills your lung cavities (mostly on your right side).
8. How best to treat ascites?
The most important step to treat ascites is to strictly reduce your salt
intake. Your doctor may advise you to limit your salt intake to 4-5
grams per day (2,000 mg of sodium) or less. As it can be difficult to
determine the salt content of various foods, it is generally recommended
that a patient with ascites see a nutritionist (dietician) for advice
about various foods to avoid. Patients may use salt substitute but it is
essential to choose one without potassium because the potassium levels
can increase with certain medications to treat ascites. It is important
to discuss with your doctor or the dietician which salt substitute you
are planning to use.
Most often, patients will require water pills (diuretics) to treat
ascites. Your doctor will choose appropriate doses of water pills such
as spironolactone (Aldactone) and/or furosemide (Lasix). As these water
pills can cause problems with your electrolytes (levels of sodium,
potassium, chloride, and bicarbonate in the blood stream), your doctor
will need to monitor your blood levels closely. It is important to
realize that taking water pills is not a substitute for reducing your
salt intake, as water pills will work only when they are taken together
with restricted salt intake.
Checking your body weight daily on a scale and contacting your physician
whenever there is a gain of more than 10 lbs (or greater than 2 lbs per
day for 3 consecutive days) is a good strategy for better management of
When fluid accumulation cannot be treated optimally with water pills and
salt restricted diet, patients may require a large amount of fluid be
removed (paracentesis) for relief of symptoms. Your doctors may also
discuss with you other procedures such as having a radiologist place a
shunt within the liver (called TIPS) to prevent significant fluid
accumulation from ascites. As mentioned, patients with ascites have a
serious health risk and are often evaluated for liver transplantation.