Ascites - Symptoms, causes and treatment

Ascites or ascites is the accumulation of fluid in the cavity between the membrane that covers the wall stomach and organs inside the body. This cavity is called peritoneal cavity. Liquid buildup in the peritoneal cavity will cause the stomach to enlarge.

Ascites is most often caused by liver disease and a lack of protein (albumin). Albumin is a type of protein that functions to bind fluids. When the body lacks albumin or hypoalbuminemia, the fluid in the cells will leak into the surrounding tissues, including the peritoneal cavity.

This fluid buildup will cause a variety of symptoms, including abdominal pain, bloating, and an enlarged stomach.

Causes of Ascites

The organs in the stomach are covered by a pouch or membrane called the peritoneum. Normally, the peritoneal cavity (cavity within the peritoneum) contains only a small amount of fluid. In women, the peritoneal cavity can contain about 20 ml of fluid, depending on the menstrual cycle they have.

Ascites occurs when the amount of fluid in the peritoneal cavity is more than 25 ml. This condition is often caused by liver disease or a decrease in the amount and production of albumin.

Liver disease will cause an increase in hepatic venous pressure which further increases the risk of fluid leaking from the blood vessels into the surrounding tissues, including the peritoneal cavity.

Below are some liver diseases that can trigger ascites:

Cirrhosis
Cirrhosis is the appearance of scar tissue in the liver that causes decreased liver function or liver failure.
Acute liver failure
Acute liver failure due to injury to liver cells that can be caused by side effects of drugs or drug abuse.
Budd-Chiari syndrome
This syndrome is caused by blockage of the hepatic veins, resulting in increased blood pressure in the liver (portal hypertension).
Heart cancer
Liver cancer can make the peritoneum perforate or increase liver pressure so that fluid enters the peritoneal cavity.

In addition to some of the liver diseases above, there are several other diseases that can trigger ascites, namely:

1. Nephrotic syndrome

2. Heart failure

3. Pancreatic disorders

Pancreatic disorders that can increase the risk ascites are acute pancreatitis and chronic pancreatitis. Chronic pancreatitis can lead to malnutrition, for example a lack of protein. This condition then causes a decrease in oncotic pressure which in turn causes leakage of fluid into surrounding tissues, including into the peritoneal cavity and causes ascites.

4. Irritation of the peritoneum

5. Diseases of the ovaries (ovaries)

Cancer or benign tumors of the ovaries, such as Meigs syndrome It can also irritate the peritoneum causing fluid to leak into the peritoneal cavity.

Although rare, ascites can also occur in patients with untreated hypothyroidism.

Symptoms of Ascites

Symptoms and complaints that arise when a person experiences ascites can appear gradually or suddenly. This depends on the underlying cause of ascites. However, when a person has ascites, the following symptoms will usually appear:

Stomach that looks enlarged and swollen like a balloon
There is a feeling of bloating
Nausea or vomiting
Stomach ache
Shortness of breath, especially when lying down
Indigestion
A burning sensation in the chest (heartburn) due to increased stomach acid
Weight gain

In addition to the symptoms mentioned above, people with ascites can also experience swelling of the legs and ankles, swelling of the veins in the anus (hemorrhoids), fever, and loss of appetite.

When to go to the doctor

Check with your doctor if you experience the above symptoms, because ascites is usually a symptom of another disease or condition. Early detection of the cause of ascites can help doctors to treat the underlying disease, before the disease gets worse.

Immediately see a doctor if you experience symptoms that suggest liver disease, such as fever, bloody or black stools, blood in vomit, skin that bruises and bleeds easily, confusion, loss of consciousness, or yellowing of the skin and whites of the eyes (jaundice).

Ascites Diagnosis

The doctor will ask about the complaints that are felt and the patient's medical history. The doctor will then perform an examination of the abdomen, including by looking at the shape of the patient's stomach when sitting or standing, as well as checking for movements and abdominal sounds.

To find out how much fluid has accumulated and find out the cause of ascites, the doctor may ask the patient to undergo investigations, such as:

Scanning tests, such as ultrasound, CT scan, or MRI, to look for the presence and amount of excess fluid, as well as check for the underlying cause of ascites
Blood tests, to check liver function, kidney function, electrolyte levels, and albumin levels in the blood
Paracentesis by taking a sample of fluid from the abdominal cavity, to determine the number of red and white blood cells, check albumin (protein), amylase, and glucose levels, and see the presence of disease particles, such as infection or cancer
Angiography, to check blood flow, especially in the hepatic veins
Laparoscopy, to check the condition of the organs in the stomach

Ascites Treatment

Treatment of ascites aims to overcome complaints, reduce fluid buildup, and treat the disease that is the underlying cause. Treatment methods that can be done by doctors can vary, depending on the condition and cause.

There are several treatment options that can be given by doctors, namely:

Administration of drugs

Medicines work to reduce excess fluid in the body and treat the cause of ascites. Here are some types of drugs that can be used to treat ascites:

Diuretics, to increase the excretion of fluids and salts from the body thereby reducing complaints and pressure on the hepatic veins
Chemotherapy, to kill cancer cells if ascites is caused by cancer
Antibiotics, to prevent or treat infection, especially if the ascites is triggered by a bacterial infection

Medical and surgical procedures

Special medical measures to surgery can be performed to treat the disease that causes ascites while removing excess fluid buildup in the abdominal cavity. Some of the medical procedures that can be done are:

Paracentesis, to remove excess fluid from the abdominal cavity
Operation transjugular intrahepatic portosystemic shunts (TIPS), to reduce pressure in the veins
Surgery, to remove cancerous tissue
Liver transplant, to treat ascites caused by very severe liver damage

Self-medication

Independent treatment is carried out to support the effectiveness of the drug in removing water deposits from the peritoneal cavity, preventing excessive fluid absorption, as well as preventing further damage to the problematic organ. Self-care that can be done are:

Avoid consuming alcoholic beverages, to reduce the risk of worsening liver damage
Limit salt consumption, to reduce body fluid absorption,
Limiting the amount of fluids that can be drunk as directed by the doctor

Complications of Ascites

Ascites that is not treated immediately can lead to complications such as:

Peritonitis or spontaneous bacterial peritonitis, an infection of the lining of the abdominal cavity
Hepatorenal syndrome or kidney failure due to severe liver damage
Protein malnutrition and weight loss due to difficulty eating and drinking
Difficulty breathing due to fluid pressing on the diaphragm muscle
Accumulation of fluid around the lungs or pleural effusion
Loss of consciousness due to hepatic encephalopathy
Protruding bowel in the navel or umbilical hernia and protruding bowel in the groin inguinal hernia

Ascites Prevention

Ascites is difficult to prevent. However, you can live a healthy lifestyle to prevent diseases that can cause ascites. The following are some healthy lifestyles that you can adopt to prevent ascites:

Do not drink alcohol or use drugs
Maintain ideal body weight
Exercise regularly
Undergo hepatitis B vaccination and HPV vaccine
Reduce salt consumption
Drink enough water
Do not change sexual partners
Using condoms to prevent sexually transmitted infections
Using drugs according to doctor's prescription