Ascites
Portal hypertension - ascites; Cirrhosis - ascites; Liver failure - ascites; Alcohol use - ascites; End-stage liver disease - ascites; ESLD - ascites; Pancreatitis ascitesAscites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs.
Causes
Ascites results from high pressure in certain veins of the liver (portal hypertension) and low blood levels of a protein called albumin.
Albumin
Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood. Albumin c...
Read Article Now Book Mark ArticleDiseases that can cause severe liver damage can lead to ascites. These include:
Severe liver damage
Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.
Read Article Now Book Mark Article- Chronic hepatitis C or B infection
Hepatitis C or B infection
Hepatitis is swelling and inflammation of the liver.
Read Article Now Book Mark Article -
Alcohol overuse over many years
Alcohol overuse
Alcoholic liver disease is damage to the liver and its function due to alcohol abuse.
Read Article Now Book Mark Article - Fatty liver disease (non-alcoholic steatohepatitis or NASH)
- Cirrhosis caused by genetic diseases
People with certain cancers in the abdomen may develop ascites. These include cancer of the appendix, colon, ovaries, uterus, pancreas, and liver.
Other conditions that can cause this problem include:
- Clots in the veins of the liver (portal vein thrombosis)
-
Congestive heart failure
Congestive heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Read Article Now Book Mark Article - Pancreatitis
- Thickening and scarring of the sac-like covering of the heart (pericarditis)
Kidney dialysis may also be linked to ascites.
Symptoms
Symptoms may develop slowly or suddenly depending on the cause of ascites. You may have no symptoms if there is only a small amount of fluid in the belly.
As more fluid collects, you may have abdominal pain and bloating. Large amounts of fluid can cause shortness of breath. This happens because the fluid pushes up on the diaphragm, which in turn compresses the lower lungs.
Many other symptoms of liver failure may also be present.
Exams and Tests
Your doctor will do a physical exam to determine if the swelling is likely due to fluid buildup in your belly.
You may also have the following tests to assess your liver and kidneys:
-
24-hour urine collection
24-hour urine collection
A 24-hour urine protein measures the amount of protein released in urine over a 24-hour period.
Read Article Now Book Mark Article - Electrolyte levels
- Kidney function tests
- Liver function tests
- Tests to measure the risk of bleeding and protein levels in the blood
- Urinalysis
- Abdominal ultrasound
- CT scan of the abdomen
Your doctor may also use a thin needle to withdraw ascites fluid from your belly. The fluid is tested to look for the cause of ascites and to check if the fluid is infected.
Use a thin needle
Liver transplant is surgery to replace a diseased liver with a healthy liver.
Read Article Now Book Mark ArticleTreatment
The condition that causes ascites will be treated, if possible.
Treatments for fluid build-up may include lifestyle changes:
Lifestyle changes
Cirrhosis is scarring of the liver and poor liver function. It is the most advanced stage of chronic liver disease. You were in the hospital to tre...
Read Article Now Book Mark Article- Avoiding alcohol
- Lowering salt in your diet (no more than 1,500 mg/day of sodium)
- Limiting fluid intake
You may also get medicines from your doctor, including:
- "Water pills" (diuretics) to get rid of extra fluid
- Antibiotics for infections
Other things you can do to help take care of your liver disease are:
- Get vaccinated for diseases such as influenza, hepatitis A and hepatitis B, and pneumococcal infection
- Talk to your doctor about all medicines you take, including herbs and supplements and over-the-counter medicines
Procedures that you may have are:
- Inserting a needle into the belly to remove large volumes of fluid (called a paracentesis)
- Placing a special tube or shunt inside your liver (TIPS) to repair blood flow to the liver
Special tube or shunt
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new connections between two blood vessels in your liver. You may need ...
Read Article Now Book Mark Article
People with end-stage liver disease may need a liver transplant.
Liver transplant
Liver transplant is surgery to replace a diseased liver with a healthy liver.
Read Article Now Book Mark ArticleIf you have cirrhosis, avoid taking nonsteroidal anti-inflammatory medicines, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Acetaminophen should be taken in reduced doses.
Possible Complications
Complications may include:
-
Spontaneous bacterial peritonitis (a life-threatening infection of the ascitic fluid)
Spontaneous bacterial peritonitis
The peritoneum is the thin tissue that lines the inner wall of the abdomen and covers most of the organs in the abdomen. Peritonitis is present when...
Read Article Now Book Mark Article -
Hepatorenal syndrome (kidney failure)
Hepatorenal syndrome
Hepatorenal syndrome is a condition in which there is progressive kidney failure that occurs in a person with cirrhosis of the liver. It is a seriou...
Read Article Now Book Mark Article - Weight loss and protein malnutrition
- Mental confusion, change in the level of alertness, or coma (hepatic encephalopathy)
- Bleeding from the upper or lower gastrointestinal tract
- Build-up of fluid in the space between your lungs and chest cavity (pleural effusion)
- Other complications of liver cirrhosis
When to Contact a Medical Professional
If you have ascites, contact your health care provider right away if you have:
- Fever above 100.5°F (38.05°C), or a fever that does not go away
- Belly pain
- Blood in your stool or black, tarry stools
- Blood in your vomit
- Bruising or bleeding that occurs easily
- Build-up of fluid in your belly
- Swollen legs or ankles
- Breathing problems
- Confusion or problems staying awake
- Yellow color in your skin and the whites of your eyes (jaundice)
References
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 144.
National Institute of Diabetes and Digestive and Kidney Diseases website. Cirrhosis. www.niddk.nih.gov/health-information/liver-disease/cirrhosis/all-content. Updated March 2018. Accessed November 11, 2022.
Sola E, Gines SP. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 93.
-
Ascites with ovarian cancer - CT scan - illustration
This CT scan of the lower abdomen shows a massive amount of free abdominal fluid (ascites) in a patient with ovarian cancer.
Ascites with ovarian cancer - CT scan
illustration
-
Digestive system organs - illustration
The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.
Digestive system organs
illustration
-
Ascites with ovarian cancer - CT scan - illustration
This CT scan of the lower abdomen shows a massive amount of free abdominal fluid (ascites) in a patient with ovarian cancer.
Ascites with ovarian cancer - CT scan
illustration
-
Digestive system organs - illustration
The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.
Digestive system organs
illustration
Review Date: 7/30/2022
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.