What can you do for your ascites? ~Medical Treatment Options~

The medical treatment options for ascites vary depending on the severity of it.  Most often, a combination of changing eating and drinking habits with some kind of medication help to treat ascites.

• Medications used:

1. Diuretics: cause you to urinate more often in order to decrease the fluid.  It will cause weight loss and there are different amounts of weight that should be lost each day depending on what your doctor tells you. 
2. Antibiotics: if there are infections that are due to bacteria in the ascitic fluid, the antibiotics can help to fight them if they arise.  

• Changes in diet:

1. Sodium restriction 
2. Decrease in liquid intake

http://depts.washington.edu/hepstudy/mgmt/mgmt/ascitesMgmt/discussion.html

• Procedures:

1. Paracentesis: draining the fluid from the abdomen with a needle.
2. Transjugular intrahepatic portosystemic shunt (TIPS): changes the direction of the fluid from the portal vein into the central blood circulation by use of a catheter. 
3. Liver transplant: A liver transplant may be needed in the case of severe cirrhosis of the liver which may be causing the ascites.  

References:
http://www.drugs.com/cg/ascites.html
http://www.nytimes.com/health/guides/disease/ascites/overview.html
http://www.emedicinehealth.com/ascites/page7_em.htm#medical_treatment

Signs and Symptoms!

The signs and symptoms of ascites can vary depending on the cause, but the most obvious symptom of ascites is the swelling of the abdomen from the accumulation of fluid in the peritoneum.  The pressure of the fluid on the diaphragm also can cause discomfort and shortness of breath in people with more severe ascites.

http://patient.info/doctor/ascites

A person with ascites may experience one or many of the following:

• Abdominal swelling
• Shortness of breath 
• Feelings of heaviness or fullness 
• Pain 
• Weight loss
• Fatigue 

*PAIN* If a person develops spontaneous bacterial peritonitis, they may experience pain in the abdomen and fever.  Experiencing pain in the abdomen when you have ascites should be addressed by a medical professional.  Spontaneous bacterial peritonitis is a bacterial infection of the ascitic fluid and has a mortality rate of 40-70% depending on the age of the patient and the diagnosis and treatment options available. 

http://www.nbcnews.com/health/chronic-stomach-pain-kids-linked-later-anxiety-6C10887554

References:

http://emedicine.medscape.com/article/789105-overview

http://www.emedicinehealth.com/ascites/page3_em.htm

http://medvin2u.net/ascites/

http://www.drugs.com/cg/ascites.html

~Diagnosis~

Ascites has quite a few ways to be diagnosed.

Paracentesis:  http://medvin2u.net/ascites/

• Ascitic fluid testing is done by paracentesis to try to find the cause of the ascites.  A needle is stuck into the skin of the abdomen to draw out some of the ascitic fluid.
• An ultrasound of the abdomen helps the healthcare provider to see the internal organs and exactly where the ascitic fluid is building up.  Can be a good precursor to paracentesis.  
• Urine and blood tests help to see how well the kidneys and liver are working. 
• A CT scan can help to view the organs and blood vessels in your abdomen to see where the fluid is coming from.  
• A physical examination can also be done by the doctor to help determine the amount of swelling. 
• The fluid that is collected from the needle in paracentesis is tested and checked for its protein level, albumin, and red and white cell counts.

CT Scan: http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Surgery/Ascites.htm

• Serum-Ascites Albumin Gradient (SAAG)- helps more to determine the cause of the ascites.  Portal hypertension is assumed to be the cause if there is a high gradient greater than 1.1 g/dL.  If the gradient is less than 1.1 g/dL, it is assumed that the cause does not have to do with portal hypertension.  

References:
http://www.nytimes.com/health/guides/disease/ascites/overview.html
http://www.drugs.com/cg/ascites.html
http://medvin2u.net/ascites/

Etiology/ Pathophysiology of Ascites

The accumulation of ascitic fluid is due to an excess of sodium and water in the body.  But there are a few different theories that propose the actual cause of ascites because that is still somewhat unclear.  The theories are the under-filling, overflow, and peripheral arterial vasodilation theories.

http://medical-dictionary.thefreedictionary.com/Peritoneal+cavity+fluid
1) Under-filling Theory: the kidneys' sodium and water retention is due to ineffective blood volume circulation and portal hypertension which causes the splanchnic vascular bed to fill up with fluid in the wrong manner.

2) Overflow Theory: proposes that the main problem in ascites is that the kidney does not retain sodium and water as well as it should even when the volume is not abnormally low.

3) Peripheral Arterial Vasodilation Theory: includes parts of both of the above theories.  Suggests that portal hypertension causes vasodilation and a less effective arterial blood volume but also that more sodium in the kidney is retained and the volume of plasma expands as the disease that is causing the ascites continues.  The excess of fluid from the renal retention of sodium ends up overflowing into the peritoneum.  Says that usually in the earlier stages under-filling is common and overflow is common later in the progression of the disease which is usually cirrhosis.

    

https://www.netterimages.com/pathophysiology-of-ascites-formation-labeled-runge-im-2e-internal-medicine-frank-h-netter-19946.html


References:
http://emedicine.medscape.com/article/170907-overview#a5

What's the big deal? ~Epidemiology~

Epidemiology deals with the incidence, distribution, and control of a disease in a population.  Since ascites is a result of certain diseases and not necessarily a disease, there is not much information about the epidemiology of it.  Ascites has a prevalence of 10% when it comes to cirrhosis of the liver.  It is the most common complication of it.  Unfortunately, ascites has only a 56% chance of survival three years after its onset.  It has also been shown that patients with a case of cirrhotic ascites have a three year mortality rate of 50%.  Ascites can be minimized by different means such as draining the fluid of the peritoneum, but sometimes the fluid quickly returns or doesn't go away, which is called refractory ascites.  Refractory ascites has only a one year survival rate of less than 50%.  Ascites increases the morbidity of cirrhosis because it can bring along other complications.  These complications include hepatorenal syndrome- a type of kidney failure, and spontaneous bacterial peritonitis which is an infection of the ascitic fluid which has a reported incidence between 7 and 30% of people with ascites.  It has been stressed that when ascites becomes apparent, it is important to understand the pathophysiology in order to adequately treat it and prevent further complications.  

In healthy people, it has appeared that men have little to no fluid in their peritoneum, but women may have as much as 20mL, depending on their menstrual cycle.

References:

http://www.merriam-webster.com/dictionary/epidemiology

http://emedicine.medscape.com/article/170907-overview#a6

http://www.ncbi.nlm.nih.gov/pubmed/22541699

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886420/

Picture from:

http://emedicine.medscape.com/article/170907-overview

What in the world is ascites?

Ascites is the swelling of the abdominal cavity due to the buildup of protein-containing (ascitic) fluid in the peritoneum.  Ascites often results from cirrhosis of the liver, but can also be due to pancreatitis, heart or kidney failure, and different cancers in the abdomen.  













  https://flowvella.com/s/1y65/1E1130A4-6820-4C2F-9C70-A36D012AC117

 The ascitic fluid often accumulates due to the kidneys retaining fluid, changes in hormones and chemicals that regulate the fluids in the body, and portal hypertension.

http://www.4to40.com/ayurveda/index.asp?p=Ascites_(Ayurvedic_Name-_Jalodar)

References:

• http://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/ascites
• https://www.nlm.nih.gov/medlineplus/ency/article/000286.htm