Definition

Ascites is the accumulation of fluid in the peritoneal cavity, which is the space between the abdominal wall and the internal organs. The cavity is known as the peritoneal cavity. The accumulation of fluid in the peritoneal cavity leads to stomach enlargement. Hepatic dysfunction and hypoalbuminemia are the main causes of ascites. Albumin is a protein that serves to bind fluids. When the body has hypoalbuminemia, fluid from the cells will seep into the surrounding tissue. The accumulation of fluid will result in the manifestation of several symptoms, such as abdominal pain, bloating, and an enlarged abdomen.

Causes

The peritoneum, a membrane, covers the abdominal organs to protect them. Women can have approximately 20 cc of fluid in the peritoneal cavity, which varies based on their menstrual cycle. Ascites develop when the volume of fluid in the peritoneal cavity exceeds 25 ml. Liver disease or reduced albumin protein levels commonly lead to this syndrome.

Here are several disorders that might cause ascites:

• Hepatic disorder. Hepatic disorders can lead to elevated pressure in the hepatic blood vessels, raising the likelihood of fluid seepage from the blood vessels into the nearby tissue.
• Cirrhosis leads to liver failure. Cirrhosis is the development of fibrous tissue in the liver, leading to reduced liver function. Acute liver failure is frequently the result of pharmacological side effects or drug addiction that can harm liver cells.
• Budd-Chiari syndrome. This syndrome is a result of obstructions in the hepatic veins, leading to elevated blood pressure in the liver, known as portal hypertension.
• Hepatocellular carcinoma. Cancer can perforate the peritoneum or elevate pressure on the liver, causing fluid to accumulate in the peritoneal cavity.
• Nephrotic syndrome. This disorder arises from kidney impairment, causing proteins that should be retained in the body to be excreted in the urine. Insufficient protein leads to a decrease in pressure, which in turn causes fluid to flow.
• Cardiac failure. This disorder can lead to ascites as a result of the heart muscle's failure to effectively circulate fluid and blood in the body.
• Pancreatic disorders. This condition raises the risk of ascites due to pancreatic inflammation, leading to malnutrition and subsequent protein deficiency. Moreover, this situation results in fluid seeping into the adjacent tissue.
• Ovarian diseases. Organic diseases can potentially inflame the peritoneum, leading to fluid leakage into the peritoneal cavity.
• Albumin protein deficiency. Albumin is a protein that binds fluids.

Risk Factors

Liver dysfunction is the main cause of ascites. Several factors that can elevate the chance of developing ascites due to liver illness include:

• Persistent alcohol intake
• Experiencing jaundice or chronic liver inflammation
• Injecting drugs with a syringe
• History of polyamory
• History of having tattoos
• Perform a blood transfusion
• Having homosexual or heterosexual relations
• Obesity
• Hypercholesterolemia (high cholesterol)
• Diabetes mellitus
• Cancer

Symptoms

Ascites can lead to symptoms like:

• sensations of tightness and discomfort in the abdomen
• The stomach enlarges as a result of pressure on surrounding organs
• Rapid weight gain
• Epigastric pain
• Dyspnea that is exacerbated by supine position. Fluid accumulation in the chest happens when fluid collects in the pleural cavity
• Loss of appetite
• Nausea and vomiting
• Pressure on the stomach due to fluid buildup results in protrusion of internal abdominal organs at the navel (umbilical) or groin (inguinal).

Diagnosis

An in-depth interview (anamnesis) is necessary to diagnose ascites, focusing on:

• Experienced symptoms
• History of other diseases considered to be the cause
• Sexual history
• Vaccination history

This diagnosis can be validated by physical and supportive exams. Body condition is monitored during a physical exam. A physical examination can reveal ascites if the stomach has more than 500 cc of fluid. If the fluid volume is modest, numerous tests may be needed.

• Ultrasound to confirm ascites
• CT scan. Abdominal tumors or other underlying disorders require this assessment
• Paracentesis. This treatment involves microscopic abdomen fluid examination. After local anesthesia, fluid is collected with a needle.
• Blood test. Ascites patients usually have blood clotting difficulties due to liver problems, so this exam is also needed to assess their overall health.

Management

Acute ascites could be treated with:

• A diuretic medication. This medication eliminates water and sodium from the body. Ascites complaints may potentially be diminished through the removal of surplus water.
• Paracentesis. A lengthy needle is utilized to extract surplus fluid from the stomach in order to accomplish this. When recurrent ascites do not respond to diuretic medications, this technique is rarely employed.
• Surgery. In severe cases, ascites may be managed surgically. A tube will be inserted into the body in order to increase hepatic blood flow.

Complications

There are several potential complications that may ensue in the absence of prompt treatment for ascites, which include:

• Peritonitis is an infection affecting the lining of the abdominal cavity.
• Severe liver damage-induced renal failure, also known as hepatorenal syndrome
• Deficiency in nutrients, particularly protein, can lead to weight loss as a consequence of impaired appetite and thirst.
• As a result of fluid pressing on the diaphragm muscle and fluid accumulation around the lungs (pleural effusion), respiration becomes difficult.
• Hepatic encephalopathy, characterized by impaired liver metabolism, decreases consciousness.
• Hernia is the protrusion of an internal organ; it can manifest in either the pelvis or the navel (umbilical or inguinal).

Prevention

Preventive actions can be taken to avoid the development of ascites, a condition caused by an underlying disease. Preventive measures that can be taken include:

• Adopting healthy habits includes abstaining from alcohol, achieving an optimal body weight, and engaging in regular exercise.
• Vaccinations for infections like hepatitis B and HPV that can lead to ascites.
• Decreasing salt intake
• Stay adequately hydrated
• Remaining monogamous
• Use condoms to avoid contracting sexually transmitted illnesses.
• Follow the doctor's directions when using medications.

When to See a Doctor?

It is advisable to promptly seek medical attention if you have symptoms such as fever, red or black feces, vomiting blood, easy bruising or bleeding, decreased consciousness, yellow eyes, or suspected ascites. Ascites is a sign of an underlying disease or condition. Timely identification of the etiology of ascites can assist physicians in managing the primary condition before it progresses.

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