The peritoneum, a sac or membrane, surrounds and protects the abdominal organs. The peritoneal cavity typically only contains a small quantity of fluid. However, this might change in women based on the menstrual cycle (by 20ml or less than an ounce). Many diseases can cause the fluid to accumulate. The reasons that ascites occur may vary for each disease. Peritoneum cancer can cause a direct leakage of fluid. Water retention in the body is a symptom of several disorders. Eventually, this liquid may seep into the peritoneal cavity. This condition is known as ascites.
Causes of Ascites
Regardless of the etiology of liver failure, an unhealthy liver cannot produce enough protein to retain the oncotic pressure necessary to keep fluid in the circulatory system.
Ascites resulting from liver issues may be caused by the following:
Cirrhosis
Cirrhosis is a type of liver disease in which scar tissue replaces damaged liver tissue. This leas to progressive liver failure as more and more liver tissue is lost.
Liver failure
Ascites may develop from acute liver failure, which may be brought on by an insult to the liver cells, such as negative drug interactions or drug addiction. For example, liver failure is the major consequence of acetaminophen overdose.
Ascites, stomach discomfort, and hepatosplenomegaly are the trinity of symptoms that characterize Budd-Chiari syndrome, which is brought on by obstruction of the hepatic veins.
Ascites may also originate from cancer that has progressed to the liver or metastasized there.
Heart failure
Heart failure is characterized it the inability of the heart muscle to pump blood within the blood vessels. This can result in a number of issues, but most significantly, fluid backs up into the lungs and other organs. This causes them to fail. This water overload can result in leakage into the peritoneal cavity and the development of ascites.
Nephrotic syndrome
Nephrotic syndrome lowers oncotic pressure by causing the protein to flow into the urine as a result of kidney injury.
Acute pancreatitis
Acute pancreatitis is an inflammation of the pancreas. It can lead to fluid buildup as a byproduct of the inflammatory response. Chronic pancreatitis can cause malnutrition, which can cause decreased total body protein, a drop in oncotic pressure, and ascites. Also, pancreatic cancer can directly lead to fluid loss.
Infection
An infection or malignancy (cancer) may directly irritate the peritoneum, causing it to leak fluid as part of the inflammatory process.
Ovarian disorders
Ascites are a symptom of several ovarian diseases, including cancer of the ovary, which has no early symptoms and is frequently diagnosed as ascites. Meigs syndrome is a benign ovarian tumor called a fibroma. It presents with ascites and pleural effusion, i.e., fluid in the cavities around the lungs. The hard surface of the ovarian tumor may significantly irritate the peritoneum, causing it to leak fluid.
Hypothyroidism
When hypothyroidism (low thyroid function) occurs, ascites is a rare complication that often develops after the condition has gone untreated.
Ascites Signs and Symptoms
There is a difference between individuals who develop ascites due to cirrhosis and liver illness and those who do so due to peritoneal inflammation brought on by cancer.
Due to the fluid accumulation, the abdomen swells. Shortness of breath might result from this since the diaphragm, the flat muscle separating the chest from the belly, may find it challenging to help with breathing. In contrast to cancer patients, those with a liver illness often don’t feel much discomfort.
It is usually the symptoms of the underlying disease that initially prompt the patient to seek medical attention. Ascites fluid may initially be little and hard to notice, but a tight belly loaded with fluid is straightforward to identify. The patient may express feelings of fullness or heaviness in the belly as the number of fluids rises.
In addition to fluid buildup in the abdominal cavity, cirrhosis of the liver may also cause:
- the swollen legs
- simple bruising,
- expansion of the breasts, and
- bewilderment brought on by encephalopathy
Those who have ascites from heart failure often have paroxysmal nocturnal dyspnea, which causes them to wake up at midnight. Shortness of breath may accompany leg swelling edema if heart failure is the underlying cause of the ascites, and it tends to become worse with movement and while resting flat orthopnea.
Cancer patients may complain of the following signs and symptoms:
- pain,
- decrease in weight, and
- weariness and abdominal bloating together.
Abdominal discomfort and fever are symptoms of spontaneous bacterial peritonitis, which is an infection of the peritoneum.
Treatment for ascites
The origin of the ascites buildup, how rapidly the fluid collected, whether it was a one-time or recurring occurrence, and how much the symptoms affected the patient all influence the treatment strategy. Breathing difficulties and severe pain may result from an abundance of fluid in the stomach cavity.
Spironolactone is a first-line diuretic drug. It helps block the chemical aldosterone, which is responsible for salt retention in the body, as well as furosemide (Lasix) and metolazone (Zaroxolyn), which may also be added, is the initial therapy for ascites in patients with cirrhosis. This treatment is effective in controlling the accumulated ascites fluid.
Diuretic treatment aims to lose one to two pounds of weight each day, depending on underlying medical issues. After the majority of the ascites fluid has been eliminated, the medication dose will be tailored to the patient’s requirements.
Water restriction may be an option if there is hyponatremia (low serum sodium).
When should you get medical attention for ascites?
The primary care physician and any specialists who may be engaged in the patient’s treatment should check in on the patient on a regular basis if they have ascites. Ascites caused by liver illness is a frequent condition seen by gastroenterologists (experts in gastrointestinal disorders) and hepatologists (liver specialists).
Depending on the underlying disease and potential causes of ascites, other professionals may also be able to help patients. If ascites worsen, the experts often advise the patient to speak with their primary care physician first. If ascites is resulting in symptoms like these:
- breathing difficulty
- Uncomfortable stomach
- unable to do basic everyday activities like walking
Frequently asked questions
What causes ascites primarily?
Disorders that may cause significant liver damage, such as Chronic hepatitis C or B infection, can result in ascites, which is caused by portal hypertension and low blood levels of albumin.
Are ascites potentially fatal?
The most significant issue linked with ascites is an infection, which may be life-threatening. Ascites may get resolved with a low-salt diet and with diuretics prescribed by your provider. Even breathing can be a challenge, particularly while you are lying down.
What are the ascites’ three stages?
Grade 1 ascites, or mild ascites, are easy to identify by ultrasound examination. Grade 2 or moderate ascites are distinguished by mild symmetrical abdominal distension. Grade 3 or massive ascites are distinguished by considerable abdominal distension.
Conclusion
It is important that you get medical attention if you suffer from any of the symptoms like abdominal swelling, shortness of breath, leg swelling, and pain. Ascites is an abnormal condition characterized by increased fluid accumulation in the peritoneal cavity. It can be caused by one or more possible reasons, including liver failure, heart failure, cancer, or other.