Support, Support, Support!

http://webfl.alsa.org/site/PageNavigator/FL_8_SupportGroups.html

Having any kind of abnormal condition or disease can be difficult to handle if you feel like you have no support or are alone in the matter.  Sometimes it may seem like you are the only person in the world who has ascites if you don't know anyone else who has ascites also.  That it why it is important to find support groups where you can feel accepted, ask any questions you may have from other people who have experienced it also, and hear other peoples' stories about their road to treatment and recovery.  I have found an online support group and also a support group around the Portland area. Depending on where you live, you can use this website to try to find a support group near you: http://www.liverfoundation.org/chapters/pacificnw/resources/

• Online support group:  http://www.mdjunction.com/forums/cirrhosis-discussions/general-support/3355425-ascites
• Online support group: http://m.delphiforums.com/liverfailure/messages/1409
• A cancer support group (some causes of ascites) near Portland:             http://liversupportnw.org/ :the website for a support group in Portland, OR.  

References: 

 http://www.liverfoundation.org/chapters/pacificnw/resources/

http://www.mdjunction.com/forums/cirrhosis-discussions/general-support/3355425-ascites

http://m.delphiforums.com/liverfailure/messages/1409

http://liversupportnw.org/ 

Helpful Apps!

Although there are no apps that I was able to find that directly have to do with ascites, I was able to find one that is very helpful for healthcare professionals that are working with people who have had liver problems which sometimes lead to ascites.  It is called HepCalc and is an app that is made for apple devises such as iPhones.  It has a collection of calculators that have to do with the liver and you can put in information that you may have about yourself or your patients' liver.  There are alcohol hepatitis calculators, fibrosis calculators, portopulmonary hypertension calculators, and more.  If you have liver disease and are struggling with it and side effects such as ascites, I would recommend this app.  You can find it in the iTunes store and is by Gary Poleynard MD.





















References:
https://itunes.apple.com/us/app/hepcalc/id586813135?mt=8

Nursing Care for a Person with Ascites

http://www.buzzle.com/articles/ascites-symptoms.html

• It is important for nurses to make the patient feel respected and adequately cared for.  The Lippincott Advisor for Education website is a great resource for nurses to be able to look up how they should perform certain procedures such as paracentesis.  It gives detailed instructions on how to make the patient comfortable, which is a top priority, and how to accurately drain the fluid from the peritoneum.  There is also a large amount of other information about ascites and how to help the patient with the condition on the Lippincott website.  It contains expected outcomes for the condition and nursing interventions.  The information can be found at http://advisor-edu.lww.com/Ina/document.do?bid=3&did=410070&hits=ascites if you have access to Lippincott.  
• It can also be important to support your patient by offering them information and answers about ascites.  Providing them with trusted websites and references to apps that will help them on their road to recovery can help to gain their trust and respectability as they go through the treatment process.    

• An informative webpage that I would recommend to a patient with ascites would be http://www.macmillan.org.uk/information-and-support/coping/side-effects-and-symptoms/other-side-effects/ascites.html#tcm:9-46181 because it has simple language and an easy and welcoming format to read.  

References:
http://advisor-edu.lww.com/lna/document.do?bid=3&did=410070&hits=ascites

Does it matter what you eat? ~Dietary Consideration~

Diet can play a huge role in the prevention and treatment of diseases and their symptoms.  

http://www.slideshare.net/sumeryadav/ascites-51550763

1. Sodium restriction: A low sodium diet can be difficult to follow considering the sodium dense foods in the US.  But sodium causes the body to hold onto more water and in the case of ascites, it can have a negative effect.  The reduction of salt causes the person with ascites to have less salt concentration and more fluid concentration which increases the amount of urine output.  Maintaining a low sodium diet with no more than 1,500 mg/day can be important in the treatment of ascites. 
2. Decrease in liquid intake: If a low-sodium diet doesn't help reduce the amount of fluid in the abdomen, a decrease in liquid intake can possibly help prevent anymore excess fluid.  Depending on the treatment plan, it may be recommended by doctors to decrease fluid intake to about 34 ounces a day.  
3. Decreasing alcohol intake helps to prevent liver damage.  

References:

http://medvin2u.net/ascites/

http://www.nytimes.com/health/guides/disease/ascites/overview.html

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

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