February 13, 2025

Ascites refers to the abnormal accumulation of fluid in the peritoneal cavity, the space between the lining of the abdomen and abdominal organs. It is commonly associated with underlying health conditions, the most notable liver disease.

COMMON CAUSES

Cirrhosis (Most Common Cause):

  • Increased fluid leakage into the abdomen.
  • Low albumin levels and worsening fluid retention.

Cancer:

  • Peritoneal tumor spread

Heart Failure:

  • Right-sided heart failure and increased venous pressure

Kidney Disorders:

  • Nephrotic syndrome or chronic kidney disease.

Infections:

  • Tuberculosis (TB) peritonitis
  • Spontaneous bacterial peritonitis (SBP) in cirrhosis patients.

Pancreatic Disorders:

  • Pancreatic ascites from chronic pancreatitis or pseudocysts.

SYMPTOMS

The symptoms of ascites vary depending on the underlying cause and the amount of fluid accumulated in the abdomen. Common symptoms include:

General Symptoms:

  • Abdominal Swelling
  • Abdominal Pain or Discomfort
  • Shortness of Breath
  • Early Satiety
  • Nausea and Vomiting
  • Fatigue
  • Reduced Appetite

Symptoms Associated with Specific Causes:

Cirrhosis and Liver Disease:

  • Jaundice (yellowing of the skin and eyes)
  • Spider angiomas, palmar erythema
  • Enlarged spleen (splenomegaly)

Spontaneous Bacterial Peritonitis (SBP):

  • Fever
  • Worsing abdominal pain or tenderness
  • Confusion (hepatic encephalopathy)

Cancer-Related Ascites:

  • Unintentional weight loss.
  • Severe abdominal discomfort

Tuberculous Peritonitis:

  • Fever, night sweats, and weight loss

Heart Failure:

  • Peripheral edema (swelling in legs)
  • Fatigue and breathlessness

DIAGNOSIS FOR ASCITES

The diagnosis of ascites involves confirming fluid accumulation in the abdominal cavity and determining its underlying cause. This is achieved through a combination of clinical evaluation, imaging, and
laboratory tests.

Stepwise Approach to Diagnosing Ascites
Clinical Evaluation

1.History and physical examination

2.Imaging Studies one or more of above may be needed

  • Abdominal Ultrasound:
  • b)CT scan
  • c) Chest X-Ray

3.Diagnosis Paracentesis

A critical step in evaluating ascites:

  • Procedure: Aspiration of fluid from the abdominal cavity
    under sterile conditions
  • Ascitic Fluid Analysis generally includes following tests:
    a) Serum-ascites albumin gradients
    b) Total Protein
    c) Cell Count
    d)Cytology for malignant cells
    e) Microbiology
    f) ADA levels, TB PCR

4.Blood Tests some or all following tests may be required:

  • Liver Function Test (LFT)
  • Kidney function Test (KFT)
  • Complete Blood Count (CBC)
  • Coagulation Profile

5.Tests for specific Causes

  • Cancer Markers:
    CA -125(ovarian cancer), AFP (hepatocellular carcinoma), CEA (colorectal cancer)
  • TB Testing
  • Echocardiogram
    To rule out right-side heat failure

TREATMENT

Treatment focuses on addressing the underlying cause and relieving symptoms. Here’s a summary of treatment options according to Dr. Rohit Goyal

  1. Dietary Changes: Low- sodium diet and fluid restriction in severe cases.
  2. Medications: Diuretics like spironolactone and furosemide to reduce fluid
  3. Paracentesis: Draining fluid with a needle for quick relief
  4. Treating the Cause: Address liver disease, heart failure, or cancer
  5. Advanced Options: TIPS procedure or liver transplant for severe cases.
    For severe or persistent ascites, consult a gastroenterologist like Dr. Rohit Goyal

WHEN TO SEE A DOCTOR

You should consult a Dr. Rohit Goyal for ascites if you experience:

  1. Severe Abdominal Swelling: Especially if it’s rapid or uncomfortable
  2. Difficulty Breathing: Due to pressure from fluid buildup
  3. Pain or Tenderness: In the abdomen
  4. Fever: Could indicate an infection (spontaneous bacterial peritonitis)
  5. Nausea or Vomiting: Persistent symptoms
  6. Sudden Weight Gain: From fluid accumulation
  7. Leg Swelling: Edema that accompanies ascites Early evaluation and treatment are crucial to manage
    complications

OVERVIEW

Dr. Rohit Goyal, recognized as one of the best gastroenterologists in Dwarka, Delhi, offers expert care for individuals suffering from ascites. With his extensive experience and patient-focused approach, Dr. Rohit Goyal provides comprehensive diagnosis and effective treatment for ascites, addressing underlying causes such as liver disease, heart failure, or cancer. His expertise includes advanced diagnostic tools like endoscopy and colonoscopy, as well as evidence-based treatments such as diuretics, therapeutic paracentesis, and personalized management plans. For complex cases, he offers advanced options like TIPS and guidance on liver transplantation when necessary. Whether managing mild symptoms or advanced cases of ascites, Dr. Rohit Goyal ensures optimal outcomes and improved quality of
life for his patients. For reliable and advanced care, his clinic in Dwarka is the trusted destination for those seeking relief from ascites.

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