Ascites
The term ascites describes an excessive collection of fluid in the abdominal cavity. Depending on the phase of the menstrual cycle, women may normally have up to 20 ml of fluid in the abdomen. The presence of ascites is most often the result of severe cirrhosis or end-
stage liver
disease. However, other medical problems can also cause fluid build up in the abdomen, including
cancer, alcoholic liver disease, kidney disease, and heart failure. Ascites is graded on a scale of escalating severity from 1 to 3.
A common complaint in patients with ascites is the feeling of progressive abdominal heaviness or fullness. Moreover, as the fluid compresses the diaphragm, shortness breath often develops. The signs of ascites can vary depending on the health condition responsible for its development. For example, cirrhosis patients can show bruising and swelling of the legs; cancer patients may complain of extreme fatigue or weight loss; and heart failure patients can present with shortness of breath and wheezing. Indeed, patients with cirrhotic ascites that are still able to walk have a 3-year mortality rate of 50%. Therefore, all patients with ascites are eligible to be evaluated for liver transplantation.
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options for ascites depend primarily on the severity of the condition. Switching to a low-sodium diet is often beneficial to ascites patients regardless of grade. Patients with moderate ascites do not necessarily need to be hospitalized and can be treated with varying doses of diuretics. Typical diuretics include spironolactone, amiloride, and furosemide. Severe ascites may require high doses of diuretics and the needle-guided extraction of fluid known as paracentesis. Unfortunately for severe cases, the treatment method does not extend the survival time. While paracentesis is faster, safer, and more effective, diuretic therapy is important for preventing, or at least delaying, recurrences of fluid build-up.