Ascites and Cirrhosis

Fluid buildup in the abdominal cavity (ascites) is the most common major complication of cirrhosis. But it's important to get treatment. People who have alcoholic cirrhosis may develop ascites early in the course of liver disease. Those who have other forms of cirrhosis, such as that caused by viral hepatitis, may develop ascites much later. The things that cause fluid to accumulate in the abdomen are complex, but high blood pressure in the portal vein system of the liver (portal hypertension) is an important contributor to its development.

Treatment for ascites depends on the cause.

Low-salt diet and medicines

About 90 out of 100 people with ascites caused by cirrhosis respond to treatment with a low-salt diet and medicines (diuretics) that eliminate extra fluid from the body.

• Diuretic medicines, such as spironolactone and furosemide, can help get rid of fluid that has built up in the belly and other parts of the body. These medicines can help both prevent and treat problems with ascites. Your doctor may prescribe a diuretic for you to take over the long term.
• Reducing your sodium intake can help prevent fluid buildup in your abdomen and chest.

Paracentesis

Paracentesis is a procedure used to collect and remove some of the fluid to help determine what is causing it to build up. Having ascites may lead to:

• Extreme discomfort, including abdominal pain and difficulty breathing.
• Infection of the ascitic fluid (spontaneous bacterial peritonitis).
• Increased fluid accumulation in the chest cavity (pleural effusion).
• Abdominal wall hernias, especially umbilical hernias. An umbilical hernia occurs when tissue from inside the abdomen bulges out through a weak spot in the navel.

Therapeutic paracentesis may be used if you have cirrhosis and you:

• Have severe ascites that is causing extreme discomfort, including abdominal pain and difficulty breathing (tense ascites). A one-time paracentesis treatment may relieve the discomfort of tense ascites before you begin treatment with one or more diuretics.
• Have not responded to standard treatment with diuretic medicine and a low-salt diet. (This is the case in fewer than 10 out of 100 people who have ascites.)

Other treatments

You may also need additional treatments such as:

• Transjugular intrahepatic portosystemic shunt (TIPS). This procedure redirects blood flow to reduce pressure in the liver's portal vein system.
• Liver transplantation. Not everyone is an acceptable candidate to receive a liver transplant.

Credits

By	Healthwise Staff
Primary Medical Reviewer	Adam Husney, MD - Family Medicine
Specialist Medical Reviewer	W. Thomas London, MD - Hepatology
Last Revised	January 17, 2012