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Ascites is a medical term, which describes the abnormal fluid accumulation inside the peritoneal cavity. According to widely accepted guidelines, the condition is diagnosed, if the amount of gathered fluid exceeds 25 ml. In females, the usual amount of fluid inside abdomen cavity is less than 20 ml. Whereas males can have little or no fluid at all. In majority of the incidents, the ascites is the sign of a liver cirrhosis, that develops especially due to either alcohol abuse or hepatitis. This specific ailment should not be neglected, since apart from complications associated with underlying disorder, it can lead to shortness of breath or various infections. What is more, incidents characterized by low serum-ascites albumin gradient (SAAG) usually have a bad outcome, due to dangerous underlying diseases. The average survival time after the diagnosis of such form is less than 58 weeks.
Although the exact mechanism of ascites development remains unclear, there is a theory that links this condition with hypertension in the hepatic portal system, which is a condition commonly known as portal hypertension. It resembles the occurrence of an oedema, due to significant difference in pressure between inside and outside system of circulation.
Based on the SAAG and possible causes, there are 2 major forms of ascites, that can by distinguished by:
- High SAAG:
- Liver cirrhosis, which is in fact the most common cause of ascites
- Congestive heart failure
- Constrictive pericarditis
- Budd–Chiari syndrome
- Low SAAG (also referred to as malignant ascites):
- Cancers, including those malignant ones
Symptoms and signs
Although in mild incidents ascites can remain unnoticeable, more serious cases will initially manifest themselves by enlarged abdomen. The victim may as well experience the feeling of abdominal heaviness, discomfort or mild to moderate pain. As the ascites progress, shortness of breath and bloating may appear gradually. Those last two symptoms occur as a consequence of high pressure applied to the abdomen and lower chest. However when considering an underlying disease, associated symptoms and signs may vary greatly. They include for instance leg oedemas, gynecomastia, general fatigue or unintentional weight changes.
Apart from eradicating the origin of the ascites alone, the specialists are able to mitigate such ailment with the help of several effective methods. At first, it is recommended to alter the patient’s diet. In order to drain the fluid from abdominal cavity, salt intake needs to be limited to less than 2 grams per day. It will further help to increase the production of urine. Nevertheless, dietary changes are frequently insufficient. That is why apart from sodium restriction, the specialist may administrate the diuretics as well. Those two methods are the most effective when combined. Occasionally, when the ascites do not relieves after few approaches, the healthcare provider might perform paracentesis. On the other hand, however, severe incidents will presumably require a surgical intervention. It can be performed in order to transplant the liver or use transjugular intrahepatic portosystemic shunt (TIPS).