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Introduction
Introduction
In cirrhosis, healthy, functioning liver cells are destroyed, and scarring and
distortion of the liver eventually takes place. As fewer liver cells function, smaller amounts of
albumin (a protein) are manufactured. Lower albumin levels facilitate water retention
(edema) in the legs and abdomen (ascites). Excessive bile product deposits cause intense
skin itching, often accompanied by jaundice (yellowed skin). Other symptoms are testicular
atrophy (Swelling of Testicles) , gynecomastia (enlargement of the male breast), and loss of
chest and armpit hair. Psychotic mental changes such as extreme paranoia can also occur in
cases of advanced cirrhosis.
WHAT IS ASCITES?
Ascites is the build-up of additional fluid in the abdomen, otherwise called the
peritoneal cavity. In mild cases, this extra fluid may not be easily observed, but in
more serious cases, the abdomen protrudes greatly, thus coming up easily in the
diagnosis of ascites.
Ascites is most often caused by cirrhosis of the liver, generally related to
alcoholism. The "beer belly" referred to by many may actually be ascites. Heart
failure can lead to accumulation of fluid in the abdomen as well as in the ankles,
wrists, feet and hands. Tuberculosis, pancreatitis and cancer of the abdomen can
also produce ascites.
The greater the accumulation of fluid, the greater pressure on the diaphragm,
which can cause shortness of breath. Most other symptoms associated with ascites
relate directly to its underlying causes. For example, a person with ascites who
also has persistent coughing and fever may be evaluated for tuberculosis. Yellow
discoloration of the skin and mucus membranes, or jaundice, indicates liver
dysfunction as the cause of ascites.
Diagnosis includes determining the presence and the cause of ascites. Physicians
usually order several blood tests, among them a complete blood count, which can
accurately gauge factors like liver function and blood-clotting ability. Most
commonly, physicians perform a paracentesis, in which a small amount of ascitic
fluid is removed via needle from the abdomen. Evaluation of this fluid can point to
specific causes of ascites.
Fluid from ascites is analyzed to evaluate serum-ascites albumen gradient (SAAG).
This gradient can either be low or high, and helps to determine the underlying
cause of ascites. In general, high SAAG indicates liver dysfunction or heart failure.
Low SAAG suggests cancer or tuberculosis.
When patients present with severe ascites, physicians use paracentesis
to slowly extract excess fluid from the abdominal cavity. For mild ascites,
patients are often put on a low sodium diet and prescribed diuretics like
furosemide, brand name Lasix.
While the patient undergoes treatment to reduce or slow the build-up of
fluid, finding and treating the cause, when possible, is ultimately the best
way to reduce ascites. Medical or surgical treatment of underlying heart
failure will slowly reduce building fluid when heart failure is causing
ascites. Antibiotics are given to treat tuberculosis. Anti-viral medications
can help resolve some forms of hepatitis.
For ascites caused by severe cirrhosis of the liver, the only appropriate
treatment may be liver transplant. Obtaining a liver transplant can be
difficult for patients who have cirrhosis due to ongoing alcoholism. Unless
a patient can successfully stop drinking, transplant units are reluctant to
list him or her, because cirrhosis will recur if alcoholic behavior
continues.
In general, when the underlying cause of ascites can be determined and
treated, outlook is good, and careful monitoring can prevent recurrence.
For those whose underlying conditions cannot be addressed, treatment
focuses on reduction of discomfort caused by ascites. Unfortunately,
ascites often signifies severe underlying conditions that shorten life
expectancy.
Current Trends in the Management of Ascites