Addressing Ascites

More and more Americans are being diagnosed with the liver disease cirrhosis. Experts say it’s on track to pass hep‌‌atitis C as the number one reason for liver transplants within the next few years. Often associated with excessive drinking, cirrhosis occurs when liver function is compromised by scar tissue and can be the result of any of a number of factors, including being overweight, even in people who don’t drink.

One effect of cirrhosis is a condition called ascites (uh-SAI-teez). Ascites can be easily ignored in its mildest forms, when it is only detectable with diagnostic imaging procedures such as CT scans; in advanced cases, it can cause discomfort and shortness of breath. People with severe ascites often complain of abdominal distension.

Ascites is the condition that used to be known as “dropsy.” It occurs when fluid collects in the abdomen as a result of what is called portal hypertension, or high blood pressure in the blood vessels leading into and out of the liver. This creates an imbalance in pressure, and fluid rushes into the abdominal cavity to correct this imbalance. Water retention is also a factor, as the kidneys sense low volume and retain sodium and water in response.

Left untreated, ascites can raise a person’s chances of infection. The condition can be treated with diuretics and reduced salt intake, though neither of those is an effective treatment alone. The patient needs to cut his or her salt consumption to less than 2 grams per day, and go on a regimen of water pills to get retained water and salt out of the kidneys. In extreme cases, a sterile needle can be used to quickly remove fluid from the abdomen.

Less directly, ascites generally goes away with treatment of the underlying cause, such as cirrhosis. In cases of complete liver failure, for example, a liver transplant will also clear up the ascites.

Cirrhosis is the most common cause of ascites, but there are a number of other ailments that can lead to the condition. It can result from any form of acute liver failure or liver cancer, or from a condition called Budd-Chiari syndrome in which the veins that blood exiting the liver goes through become blocked. Beyond the liver, heart failure, kidney disease, and pancreatitis can all lead to ascites.

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