Ascites: Understanding Causes, Symptoms, and Treatment

If the circumference of the abdomen increases, the cause is usually fat deposits that the body deposits for bad times. But there can also be disorders inside the abdomen: liver diseases, in particular, lead to fluid accumulation in the abdomen. Ascites, i.e. an accumulation of fluid (oedema) in the abdominal cavity, is not an independent disease but a symptom that can have various causes. In most cases, however, a liver disease is behind it. Ascites is a sign that indicates an advanced disease – which is why other symptoms have usually already appeared beforehand.

Causes of Ascites

The most common cause is liver cirrhosis, i.e. the connective tissue remodelling of the liver tissue, which in turn is the result of various liver diseases. Cirrhosis causes the tissues to be stiffer than usual. Whereby the vessels are exposed to a higher resistance. Therefore, the blood can no longer flow unhindered, backs up in the portal vein in front of the liver and is pressed out of the vessels into the abdominal cavity.

In addition, cirrhosis impairs liver function, and thus, fewer proteins are formed. These usually attract liquid and thus retain it in the vessels. Malignant tumors or metastases z. B. in the peritoneum can change the blood composition accordingly and thus lead to oedema. In addition, they “sweat” out water themselves.

Another cause is right heart failure, in which the pumping power of the right ventricle decreases, and the blood, therefore, backs up in the veins of the systemic circulation. Water is also pressed into the abdominal cavity, and water retention in the ankles is typical. The same happens with occlusions ( thrombosis ) of the splenic vein, portal vein or hepatic vein.

symptoms of ascites

The focus is initially on the symptoms of the underlying disease. The ascites become noticeable through the increasing abdominal circumference – so little by little, pants and belts no longer fit. The abdomen increasingly bulges outwards, the border to the navel fades away or an umbilical hernia forms.

The amount of water in the abdomen (and thus the weight gain) can be enormous – 10 litres and more are not uncommon. This causes the stomach to tense enormously, which can be very painful and lead to shortness of breath.

therapy of ascites

The ascites and their extent can easily be determined by ultrasound. The focus is on the therapy of the underlying disease, e.g. B., delaying the progression of liver cirrhosis, removing a tumour, and treating heart failure. However, ascites are usually already a sign of a poor prognosis, so in most cases, no cure can be achieved, but at most, a delay in the disease.

Ascites are counteracted by flushing the fluid using diuretics and restricting fluid intake. Ascite puncture is often performed, in which 0.5-1.5 litres of fluid are withdrawn from the abdominal cavity using a cannula. This improves the symptoms, at least for a while.

Another – often last and dangerous – therapy option is to create a short-circuit connection (portosystemic shunt) between the portal vein (in front of the liver) and the vena cava (in front of the right heart) to direct the blood past the liver and thus avoid the high pressure there. However, the liver can no longer fulfil its (remaining) function of blood detoxification, and there is an increased risk of brain damage (hepatic encephalopathy).