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Ascites

Pathological accumulation of fluid in the abdominal cavity, often a sign of cirrhosis and peritoneal disease.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Ascites?

Ascites is the abnormal accumulation of fluid in the peritoneal cavity. The most common causes in adults are cirrhosis (75%), malignancy, heart failure, and tuberculous peritonitis. Hypoalbuminemia and sodium-water retention secondary to portal hypertension form the principal mechanism of cirrhotic ascites.

Abdominal ultrasonography is a reliable and rapid method for diagnosing ascites. When new or unexplained ascites is detected, diagnostic paracentesis is mandatory; the serum-ascites albumin gradient (SAAG ≥1.1 g/dL indicates portal hypertension) helps in differential diagnosis.

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication caused by bacterial contamination of ascitic fluid; it must always be excluded in a patient presenting with fever, abdominal pain, or HE.

Symptoms

Progressive distension and tightness around the abdomen
Fullness and heaviness around the umbilicus
Shortness of breath (abdominal enlargement pushes the diaphragm upward)
Leg swelling (edema)
Fever and abdominal pain (spontaneous bacterial peritonitis)
Outward umbilical hernia (development of umbilical hernia)

Risk Factors

Liver cirrhosis (most common cause)
Pancreatic, ovarian, or colon malignancies
Congestive heart failure
Nephrotic syndrome
Tuberculous peritonitis (in endemic areas)
Liver disease due to hepatitis B or C

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If significant abdominal swelling or tightness develops
  • When shortness of breath occurs together with ascitic swelling
  • If fever and abdominal pain begin together (suspicion of SBP - emergency!)
  • If ascites worsens in a patient with known cirrhosis

Treatment Methods

01
Salt restriction: <2 g of sodium per day
02
Diuretic therapy: spironolactone (first line) plus furosemide combination
03
Therapeutic paracentesis: with IV albumin infusion in large-volume ascites (>5 L)
04
In SBP treatment: cefotaxime or piperacillin-tazobactam plus IV albumin
05
In refractory ascites: transjugular intrahepatic portosystemic shunt (TIPS)
06
Management of the underlying disease; liver transplantation in suitable candidates

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Dahiliye (İç Hastalıkları) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.