Ascites involves an accumulation of fluid in the abdominal cavity. There usually needs to be more than 1,500ml of fluid present for it to be considered ascites, but it can involve much smaller amount of fluid if the individual is thin. It most often occurs due to end stage liver failure. Many chronic alcoholics will develop this symptom due to cirrhosis of the liver. About half of the individuals with cirrhosis who develop ascites will be dead within two years.
The symptoms of ascites can include:
* Abdominal swelling
* Rapid weight gain
* Abdominal discomfort/pain
* Nausea and vomiting
* Shortness of breath
* Leg or ankle swelling
* Enlargement of the breasts
* Bruises easily
In a lot of instances the doctor will be able to note the accumulation of fluid during a physical examination. Other tests for diagnosing the condition can include:
* Blood tests to examine Creatinine, electrolyte levels, liver function, blood clotting, thyroid function, and along with a full blood count
* A 24 hour urine collection
* Abdominal CT scan and Chest x-ray
* MRI Scan
* Ascites tapping. This involves inserting a needle into the abdominal cavity in order to take a sample of the fluid.
It is possible to grade ascites based on the severity of the condition:
* Grade 1. This is when the ascites is only detectable by ultrasound
* Grade 2. There is a moderate amount of distension to the abdominal area
* Grade 3. There is a lot of distension to the abdomen
If the ascites is caused by liver cirrhosis it usually indicates a poor prognosis for the individual. The symptom itself can lead to other dangers including:
* It can make it difficult for people to breathe because of the accumulated fluid
* There is the risk of infection. Spontaneous bacterial peritonitis is an infection of the ascites fluid. This type of infection is particularly dangerous and so it is treated as emergency.
* There can be a lot of abdominal pain
* It can make eating difficult
* The fluid in the abdominal cavity may move up to the chest
* The increased pressure in the abdominal area can cause hernias to develop
* Protein malnutrition
* Kidney failure
* Hyponatraemia can occur as a result of the treatment for ascites. The diuretic medication leads to low sodium levels.
Ascites can be caused by a number of conditions including:
* Alcoholism with cirrhosis
* Cancer of the liver
* Wilson’s disease
* Cystic fibrosis
* Blood clots in the portal vein
* Kidney disease
* Congestive heart failure
Ascites is most often causes by cirrhosis of the liver. It accounts for about three quarters of all cases. This is the final stage of alcoholic liver disease and it means that the liver had been damaged beyond its ability to repair itself. The damage to the organ means that blood in unable to flow smoothly through it, and this leads to portal hypertension.
It is not completely understood how portal hypertension, but it is believed to occur because of increased sinusoidal pressure. The circulation of blood in the area is hampered and this leads to a buildup of fluid because of water retention. Sodium levels also increases.
While it is not possible to undo the damage that has been done to the liver it is usually possible to deal with the ascites. This can be done through:
* Salt restriction is usually the first step. In most instances the individual will be kept on a strict diet which includes less than 5 grams of salt per day. Salt is hidden inside many kinds of food so it will usually be necessary to involve a nutrition expert who can give advice on diet.
* It is usual for diuretics to be prescribed. This is a type of drug that encourages the kidneys to pass more water.
* It is usual for the individual to be put on some type of water intake restriction
* If the ascites is severe and shows no sign of resolving it may be necessary to perform paracentesis. This involves placing a needle into the abdominal cavity in order to remove fluid.
* The individual may be encouraged to eat potassium-rich food
Cirrhosis of the liver caused by alcoholism is the leading cause of ascites. The condition can be avoided by giving up alcohol before the liver is too damaged. Those who have developed cirrhosis can reduce the risk of developing ascites by complete abstinence and sticking to a low salt diet under the instructions of a dietician.
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