ASCITES CAUSESThere are three types of ascites. Grade 1 ascites is very mild and can only be seen through ultrasound. Grade 2 ascites causes the bulging of one's side. And, the Grade 3 ascites can be easily observed. The movement of the fluid can also be felt.
Ascites is usually associated with the infliction of cirrhosis and other liver diseases like hepatitis, portal vein thrombosis, constrictive pericarditis and liver cancer. People with congestive heart failure, nephrotic syndrome, protein-losing enteropathy and ovarian cancer may also acquire this condition. The formation of ascites is linked to having excessive amounts of salt and water in the body. Unfortunately, the cause of this condition remains to be unknown. There are, however, three theories that propose the events that led to this build up.
These three theories are the underfilling theory, the overflow theory and the peripheral artery vasodilation hypothesis.
According to the underfilling theory, the abnormal retention of fluid in the splanchnic vascular bed is caused by hypertension and the drop in the circulating blood volume. This causes the activation of the sympathetic nervous system and the increase in the production of plasma renin and aldosterone which leads to the accumulation of excess water and sodium in the body.
The overflow theory, on the other hand, states that this is caused when the volume of water and sodium are abnormally accumulated in the body and are not emptied by the body during the excretion of wastes. This is usually observed among patients who are suffering from cirrhosis.
The peripheral arterial vasodilation hypothesis states that effective blood volume is decreased by portal hypertension, leading to vasodilation. This can bring about an increase in neurohumoral excitation, leading to the retention of renal sodium and the expansion of the plasma volume. The excess fluid caused by the build up will then flow to the peritoneal cavity. This theory also suggests that the underfilling theory can be applied to the early stages of the cirrhosis while the overflow theory describes the latter part of it.
Because it's very mild, it's very difficult to pinpoint the occurence of Grade 1 ascites. Severe ascites, on the other hand, is easier to identify because the patient will feel the heaviness in the abdominal area as well as the pressure exerted by the fluid. It also causes abdominal distension. When suffering from ascites, most patients usually complain about having shortness of breath. This happens because the enlarged cavity can also exert pressure on the diaphragm.
In order to check if a person has ascites, you should also feel for deformations on the person's sides. If the patient has severe ascites, the bulge will be very visible.
ASCITES SYMPTOMSSince this condition is usually a symptom of liver problems, most doctors ask about certain events that may have caused these diseases. The first thing that they will ask about is your consumption of alcohol. They may also want to know about your sexual orientation and lifestyle. They would also inquire if you've had hepatitis before or if you've gone through a transfusion.
They will also ask about their medical history. Type 2 diabetes mellitus, obesity and hypocholesterolemia may lead to the occurrence of nonalcoholic steatohepatitis which can lead to cirrhosis in the long run.
The doctor will also give you a physical examination. He will look for signs of chronic liver disease like the presence of palamar erythema, jaundice and spider angiomas. They may also palpate the liver to see if it's enlarged. In case, the occurrence of ascites is caused by cardiac problems, they will measure your jugular venous pressure and check if a tricuspid murmur is present.
ASCITES DIAGNOSISYou will also need to go through a lot of tests. An ultrasound will be used to determine the presence of ascites. After that, you will go through, paracentesis or the extraction of the peritoneal fluid in order to determine the cause of the disease. Using this sample, they will do a cell count and measure the albumin level, the total protein, the amount of glucose, LDH, Amylase, Bilirubin and triglycerides. They will also check for fungal stains and cultures as well as the presence of cancer cells.
ASCITES TREATMENTPeople with mild ascites can be treated as out-patients. Part of this treatment is the restriction of salt from their diet. This will facilitate the movement of the liquid from the membrane to the stomach, producing urine. This will happen because the concentration of the fluid will become higher than the concentration of salt. Some patients are also given diuretics in order to counteract the hormone, adolsterone, which is responsible for increasing the retention of salt in the body. Sprironolactone, a drug that blocks the adosterone receptor, is commonly used. During treatment, the weight, the renal function and the serum potassium levels of the patients should be monitored daily. The patient shouldn't lose more than half a kilogram per day. The risks of potassium imbalance should also be avoided.
Patients who are suffering from severe cases of ascites need to be treated in the hospital. Here, they will undergo paracentesis which involves extracting the fluid from the abdomen. The risk to be watched out for when undergoing this treatment is the decrease of serum albumin levels in the blood. For people with liver problems, liver transplantation is usually recommended. In fact, the patients with both liver disease and ascites are prioritized in the list of patients who are requesting for a liver transplant. Patients who have ascites because of advanced cirrhosis, on the other hand, are treated using a process called shunting.
Medication commonly used for these disease:Ascites drugs
Blood Urea Nitrogen Test
Complete Blood Count Test
Diagnostic Medical Sonography
Liver Function Tests
Magnetic Resonance Imaging