Ascites: what it is, types, causes, symptoms, treatment and more

What is ascites?

Popularly called the water belly, ascites is the accumulation of fluids within the abdominal cavity (belly). It is a sign that points to the possibility of liver, kidney, heart disease and even tumors.

Depending on the amount of fluid, the individual has abdominal distention, that is, her belly “grows”, similar to the way that a pregnant woman’s belly increases in size during pregnancy. What is inside the abdominal cavity, however, is a liquid that can have different origins: blood plasma, lymph, bile, pancreatic juice and urine are just a few examples of what can be found in ascites.

The normal amount of fluids inside the abdominal cavity, called the peritoneum, is nil. That is, normally, there is no liquid there. If, due to some disease, there is an overflow of liquids to that part of the body, the volume can reach up to 25 liters!

It is more common in people with liver problems, especially because of diseases like cirrhosis , but it can also happen as a result of diseases in other organs.

How does ascites happen?

Our bodies are very well made. So well done that there are several ducts and channels for the passage of liquids, in order to prevent them from simply accumulating in improper places. So, if we think that all the vessels in our body remain closed and that the peritoneum is low in fluids, how is it going to get there?

Well, this liquid found in ascites comes precisely from the blood vessels that, for some reason, are unable to keep the blood in there, leading to a leak into the abdominal cavity. This can happen because of:

  • Increase in hydrostatic pressure;
  • Kidney water and salt retention;
  • Lack of blood proteins.

It is worth remembering, however, that women in menstrual periods may suffer from a slight accumulation of fluids in the peritoneum without any disease causing it. In general, the amount of liquid in these cases is between 10 and 20 mL – enough for a small swelling to be noticed, but not enough to indicate any problems.

Elevation in hydrostatic pressure

The increase in blood pressure in the veins that pass through the peritoneum, especially those known as the “hepatic portal system”, generates an enlargement of these blood vessels, which, in turn, leads to the leakage of a filtered liquid (serum).

 pores through which blood can pass smoothly. In general, this does not happen because, in the bloodstream, there are proteins that “block” these pores, preventing the blood from leaving. One of these proteins is albumin.

When these proteins are lost, the pore spaces are empty, and the blood serum starts to come out of the vessels in the same way that the water leaks into a hose filled with holes.

Severity of ascites

Ascites can be classified according to their severity, which is usually due to the volume of fluids in the abdominal cavity. Understand:

  • Grade 1: Mild ascites, usually less than 1.5 L, visible only on ultrasound;
  • Grade 2: Detectable by means of physical examination for signs such as “flanking bulging” and “mobile sub-softness”;
  • Grade 3: Clearly visible and detectable by the flick signal (liquid wave that goes from one side of the abdomen to the other).

Causes of ascites

Some of the reasons that lead to the leakage of liquid to the peritoneum are:

Portal hypertension

In the abdomen, there is a vein that goes up to the liver called the Portal Vein. It is a vein of large caliber and tends to have a low pressure normally. When, for some reason, there is hypertension in that blood vessel, there may be leakage.

The causes for portal hypertension are usually liver diseases such as cirrhosis.

Cirrhosis

The presence of scarring in the liver alters its function, bringing consequences to blood flow. There is an increase in hydrostatic pressure and water and salt levels, in addition to the loss of proteins. Thus, cirrhosis is capable of leading to ascites with volumes greater than 10 liters!

Remembering that cirrhosis can be the result of both viral hepatitis and alcohol abuse. In addition, the disease is responsible for about 85% of cases of ascites.

Nephrotic syndrome

In nephrotic syndrome, blood filtration units are damaged, leaving important proteins for blood vessels to pass into the urine. This condition is easily detectable through the observation of urine, which is too foamy in these cases.

Cardiac insufficiency

Heart failure is a condition in which the heart cannot pump enough blood for the flow to settle normally, which can lead to accumulations of blood in the blood vessels. Thus, there is an increase in hydrostatic pressure in the vessels, which ends up spilling liquids.

Pancreatitis

Because of the liver and digestive changes that pancreatitis causes, blood vessels in the peritoneum may be overloaded.

Schistosomiasis

The Schistosomiasis is a parasitic disease caused by Schistosoma mansoni. While ascites is called the water belly, schistosomiasis is also known by that name, due to the abdominal distension that the same cause.

This is because the parasite usually lodges in the mesenteric veins, just one of the largest sets of veins in the peritoneum. This housing causes an obstruction that, consequently, ends in overflow.

Cancer

Ascites can also be a complication of several types of cancer , especially when cells grow towards the peritoneum. It is more common in cases of cancer of the breast , colon, ovary, pancreas and cervix.

Types

Ascites are classified according to the composition of the liquid found in the peritoneal cavity:

Transudative

In transudative ascites, the liquid contains few proteins, low DHL, high pH, ​​normal glucose and less than 1 leukocyte per thousand cubic millimeters. This means that this type of ascites is more frequent in cases of cirrhosis and liver disease.

Exudative

In the exudate, the amount of protein is high, with low pH, high DHL, low glucose level and there is the presence of more leukocytes, indicating that the ascites was caused by an inflammation to the neoplasia.

Other ways to classify ascites are:

Chylous ascites

It is the accumulation of lymph in the abdomen, usually due to an obstruction of the lymphatic pathways.

Pancreatic ascites

It is ascites resulting from chronic inflammation in the pancreas.

Fetal ascites

It is characterized by the presence of fluids in the abdomen of the fetus or newborn. It may be a sign of a condition characterized by fetal swelling inside the uterus called fetal hydrops.

Symptoms

As it is a clinical sign of other diseases, ascites itself is a kind of symptom. It is easily seen when the individual has a very large accumulation or the individual is very thin.

However, when the volume of the liquid is very small or the condition occurs in obese people in whom the change is barely noticeable, there are some symptoms that reveal its presence:

  • Abdominal pain;
  • Breathing difficulty due to restricted diaphragm movements;
  • Feeling of pressure in the belly that increases with time, especially at bedtime;
  • Lack of appetite for abdominal pressure.

When the abdominal distention is very large, the navel can be “flattened” or even “out”.

In addition, depending on the cause, ascites usually comes with several liver symptoms, such as jaundice (yellowish color), increased liver volume, collateral circulation in the belly, among others.

Ascites in dogs and cats

As in humans, ascites in pets are the result of a lack of protein in the bloodstream, liver problems, cardiac malfunction and, often, by the presence of worms and parasites. It can also be the result of infections, internal bleeding and rupture of the urinary tract.

In general, owners only notice ascites in animals when their bellies are already quite large. At the veterinary hospital, the doctor performs a clinical examination and an ultrasound scan to check for the presence of fluids in the abdomen. If confirmed, a sample of the liquid can be taken to discover and treat the cause.

To avoid ascites in your pet, follow the tips:

  • Do not let the pet walk alone on the street;
  • Keep vaccination up to date;
  • Avoid feeding it with food, have preference for the appropriate rations for the age and size of the animal;
  • Give deworming periodically, according to veterinary guidance.

How is ascites diagnosed?

If ascites is suspected, the doctor should perform a physical examination to make sure that it is an accumulation of fluid in the abdominal cavity. This can be done by means of palpation, that is, apply light strokes on the belly to check for the sound of waves propagating in the abdomen. Sometimes, when the accumulation is less than 1 liter, this test may not show any changes.

Ultrasound

Another test that can help identify liquids inside the cavity is ultrasound, which uses sound waves to create images from inside the body. If there is liquid, the images will have characteristic changes.

Bloodtests

In order to check for possible causes of the problem, the doctor may order a complete blood count , electrolyte levels – to check the amount of salts in the bloodstream – , liver enzymes and clotting tests .

Paracentesis

This method, in addition to serving as an exam, also helps in treating the problem. This is because it consists of removing ascitic fluid for analysis of its content. Depending on what is found (proteins, defense cells of the body, etc.), one can get closer to discovering the cause of ascites.

In general, this liquid should be yellowish transparent, similar to urine. However, when there is an infection, it can be cloudy or purulent. In the case of cancer, there may be blood in this liquid.

Does ascites have a cure?

As a sign, there is really no cure for ascites. It can resolve itself with a cure for the underlying disease, but it can also come back in the case of chronic illnesses or those that do not respond adequately to treatment.

In short: ascites, in itself, is curable, but it tends to return when its cause is not treated.

How to treat?

The treatment of ascites, in itself, is done through paracentesis , a drainage procedure in which a puncture in the abdomen is connected, through a catheter, to a collection bag.

This procedure is simple and practically painless, as it is done under local anesthesia.

However, just removing the fluid from the abdominal cavity is not enough to end the problem since, if the underlying disease is not treated, it is only a matter of time before the cavity is filled with fluids again.

Thus, treatment can vary widely depending on the cause, but the use of diuretics is highly recommended while seeking to resolve the problem. The salt restriction in the feed is also beneficial because it prevents the increase of the amount of salt in the bloodstream.

When it comes to advanced cirrhosis, paracentesis is likely to be necessary from time to time, as it is no longer possible to correct the problem that causes ascites. In cases of infection, the patient will receive antibiotics at the hospital to combat the microorganism found.

Ascites Medicines

The medications recommended for ascites are those capable of draining excess fluids from the body, known as diuretics. Some examples are:

  • Furosemide ;
  • Spironolactone .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Natural treatment for ascites

In nature, there are some herbs and vegetables with a diuretic effect, that is, they help to eliminate fluids and prevent retention. People who suffer from edema and even ascites can benefit from teas and other recipes with these plants.

It is worth remembering that these methods can have several side effects and that they should not be used without first talking to your doctor, mainly due to the risk of drug interactions.

In addition, a very common misconception about diuretic teas is that they help you lose weight. In fact, with the elimination of water from the body, a little weight and “swollen belly” are lost.

However, most of these teas have no effect on fats, the real villain when it comes to losing weight. Some have substances that speed up the metabolism, favoring the burning of calories and spending the accumulated fat, but weight loss only comes in fact when the individual is engaged in exercising and eating properly.

Some teas and juices with diuretic effect are:

Horsetail tea

Horsetail is rich in potassium, flavonoids and silicon. These substances stimulate the production of collagen, a protein responsible for the firmness and elasticity of the skin. Therefore, in addition to the diuretic effect, mackerel is also indicated for anti-cellulite treatment.

Hibiscus tea

In addition to the diuretic effect, hibiscus tea is also rich in antioxidants and substances that aid in the burning of fats.

Parsley tea

Parsley, a very popular and easily found spice, has a potent diuretic effect, in addition to being rich in nutrients such as vitamin C, iron and potassium.

Green tea and mate tea

These two teas are rich in substances that help with weight loss, in addition to a large amount of caffeine, a substance with a diuretic effect.

Dandelion tea

Because it is rich in potassium, dandelion is one of the plants most often used in the treatment of kidney and urinary diseases. This is because it does not decrease the concentration of potassium in the bloodstream, which would be harmful to the body.

Onion juice

The onion is a very common vegetable in cooking, since it has a striking flavor widely used as a spice in food.

What few people know is that it also has diuretic power, especially when prepared in the form of juice, which increases the body’s water intake and favors urination.

Ascites Diet

Because of the possibility of worsening ascites due to excess salt in the bloodstream, the diet for the accumulation of fluids in the belly is based on salt restriction. However, for that, it is not enough just to stop seasoning foods with salt. There are several foods that are sources of sodium that the patient should avoid consuming.

See the table:

Types of food

What not to eat:

Prefer:

Meat

Hamburger, kebab, nuggets, meatballs, chorizo, dried meat (beef jerky), feijoada meat, extracts and broth.

Duckling, hard leg, soft leg, rump, lizard, muscle, breast, fat-free loin.

Birds

Poultry pates, extracts and chicken broth.

Chicken, turkey, chester (without skin).

Seafood

Sardines, tuna, aliche, anchovies, dried shrimp, smoked fish, salted cod.

Hake, hake, whiting, sardines etc., skinless and fresh.

Milks and derivatives

Whole milk and yogurt, powdered milk, yellow cheeses, creamy cheeses, margarine or salted butter.

Skimmed milk and yogurt, unsalted ricotta cheese, unsalted margarine.

Fried and sausages

Salami, sausage, sausage, bologna, fatty ham, ham.

Nothing.

Spices

Ready-made seasonings, meat tenderizers, monosodium glutamate (aji-no-moto), mustard, ketchup, soy sauce (soy sauce), Worcestershire sauce, miso (soy soup), mayonnaise, salad dressings, sea salt, light salt, coarse salt.

Garlic, leek, onion, green scent, strong root, kummel, basil, bay leaf, sage, oregano, sesame, tarragon, marjoram, dill, lavender, thyme, paprika, mint, paprika, fennel, rosemary, nutmeg , coriander, saffron, ginger, olive oil, dry mustard seed.

Drinks

Normal soft drinks, diet and light, energy and sports drinks, artificial juices, alcoholic drinks, tomato juice.

Water, natural fruit juice, teas.

Preserved

Pickles, olives, sauerkraut, asparagus, hearts of palm, peas, green corn, capers, select vegetables, tomato sauce extract.

Unsalted pickles, unsalted homemade preserves.

Several

Dehydrated or canned soups, snacks, peanut snacks, cashews, french fries etc., snack foods, salted water cracker, salted starch biscuit, cheese bread, stuffed pasta, pizza, sodium-based sweeteners, popcorn with salt.

Fruits, vegetables, legumes, unsalted popcorn, spaghetti pasta.

If you are going to eat something industrialized, pay attention! Even though the packaging says it does not contain salt, some ingredients can be high in sodium. Look out for the following names in the list of ingredients:

  • Monosodium glutamate;
  • Sodium alginate;
  • Sodium hydroxide;
  • Sodium propionate;
  • Sodium sulfide;
  • Sodium pectinate;
  • Sodium cyclamate;
  • Disodium phosphate;
  • Sodium saccharin;
  • Sodium benzoate;
  • Sodium bicarbonate;
  • Sodium caseinate.

Watch out for medications too, which can be hidden sources of sodium. An example is sodium dipyrone , an analgesic medication often used in colds.

Complications

When left untreated, ascites can have some serious complications. Are they:

Infection and sepsis

Accumulated fluids are always a good place for the proliferation of bacteria. When bacteria present in the intestine – beneficial to it but bad for the rest of the body – find their way into the peritoneal cavity, it gives rise to spontaneous bacterial peritonitis , that is, infection of the peritoneum by bacteria already present in the body.

If this is not resolved soon, these bacteria can come into contact with the bloodstream and be carried to the entire body, giving rise to sepsis : a highly fatal generalized infection.

Hepatic encephalopathy

Liver disease often alters the function of the organ, which is supposed to eliminate toxic products from the diet. When he fails to do so, these toxins begin to circulate through the bloodstream and reach the central nervous system, which can lead to mental confusion and coma.

Can ascites kill?

Ascites, in itself, is not capable of killing, as it is just an abnormal accumulation of fluids in the abdominal region. However, the diseases that cause this signal can easily lead to death. In addition, if complications such as infections are not treated, the possibility of death increases.

How to prevent ascites?

There is no exact way to prevent ascites, only the diseases that trigger it. Some tips for this are:

  • Avoid excessive consumption of alcoholic beverages in order to prevent cirrhosis;
  • Drink at least 2 liters of water a day to avoid overloading the kidneys;
  • Maintain a balanced diet with little salt;
  • Be up to date with hepatitis A and B vaccines;
  • Use boots and gloves when coming into contact with impounded water that can be the habitat of the schistosomiasis host.
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