Ascites- This is a pathological condition of the abdomen in which there is excessive accumulation of fluid in the abdominal cavity resulting in numerous symptoms. Several diseases involving peritoneum, pancreas and kidney cause ascites. In this article, we will discuss in detail about the various causes, symptoms, and treatment for Ascites.

Ascites: Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Complications

How Is Ascites Defined?

  • Fluid Accumulation- Ascites is a disease caused by fluid accumulation within abdominal cavity.
  • Peritoneal Cavity- Abdominal cavity is also known as peritoneal cavity.
  • Peritoneum1- Abdominal organs are covered by visceral peritoneum and abdominal wall is covered by parietal peritoneum. The space between visceral and parietal peritoneum is known as peritoneal or abdominal cavity
  • Fluid Secretion- Fluid collected within abdominal cavity is secreted by capillaries of the abdominal peritoneum.
  • Serous Fluid- Ascites fluid is pale yellow serous fluid.
  • Paracentesis- Paracentesis is a surgical procedure used for removal of ascites fluid. Needle is placed in the abdominal cavity and fluid is collected for lab studies.
  • Portal Hypertension- Ascites is caused as a result of high pressure in portal vein.
  • Hypoproteinemia- Low serum (blood) albumen level decreases blood osmotic pressure, which result in capillary oozing of water into abdominal cavity.

Causes Of Ascites

Liver Diseases

  • Hepatitis- A, B, C, D and E
  • Cirrhosis2
  • Carcinoma of Liver
  • Portal Hypertension
  • Portal Vein Thrombosis

Cardiac Diseases

  • Congestive Heart Failure
  • Constrictive Pericarditis

Peritoneal Disease

  • Peritonitis3
    • Bacterial infection
    • Fungal infection


  • Pancreatitis
  • Pancreatic carcinoma


  • Nephrotic Syndrome

Lymphatic System

  • Non-Hodgkin Lymphoma
  • Burkett's Lymphoma

Risk Factors For Ascites

  • Alcohol
  • Low protein diet
  • Hepatitis
  • Cirrhosis2
  • Cardiac disease

Symptoms Of Ascites

Nonspecific Symptoms And Signs Of Ascitis:

  • Weight loss
  • Malnourishment
  • Loss of appetite
  • Weakness and fatigue

Specific Symptoms And Signs Of Ascitis:

A. Symptoms Caused By Abdominal Distension

  • Mild to moderate pain
  • Shortness of breath
  • Abdominal distension
    • Grade 1- Mild distension visible on ultrasound or CT scan
    • Grade 2- Flank bulging and shifting dullness
    • Grade 3- Observed on examination, fluid movement felt during palpation

B. Symptoms Caused By Disease Causing Ascites

  • Liver Disease
    • Fatigue
    • Weight loss
    • Nausea and vomiting
    • Jaundice- Yellow discoloration of the skin and urine
    • Pruritus- Itching
  • Cardiac Disease
    • Angina- Chest pain
    • Shortness of breath
    • Palpitation
    • Rapid heartbeats- Tachycardia
    • Dizziness
    • Sweating
    • Pancreatic Disease
    • Loss of appetite
    • Abdominal pain
  • Kidney Disease
    • Flank pain
    • Low urine output
    • Edema feet- swelling of ankle and feet
    • Muscle twitches
    • Hiccups

Diagnosis Of Ascites

Urine Examination

  • Urine output- 24 hours urine collection
  • Urine protein
  • Urine analysis

Blood Examination

  • Electrolytes
  • Liver function test
    • Aspartate aminotransferase (AST),
    • Alanine aminotransferase (ALT),
    • Alkaline phosphatase
    • 5' nucleotidase
    • Gamma-glutamyl transpeptidase (GGT)
  • Kidney function test
    • Serum creatinine
    • Glomerular filtration rate
    • Blood Urea Nitrogen

CT Scan Abdomen-

  • Check Abdominal Organs- Liver, Kidney, Intestine and pancreas

MRI Abdomen

  • Check Abdominal Organs- Liver, Kidney, Intestine and pancreas

Ultrasound Abdomen

  • Confirmed ascites
  • Check kidney, pancreas and liver.

Treatment For Ascites

The treatment for Ascites is dependent on the underlying cause. The accumulation of the fluid in the peritoneal cavity may be treated with certain changes in an individual's lifestyle like:

Conservative Treatment For Ascitis-

  • Abstaining from alcohol
  • Consuming a low salt diet
  • Limited fluid intake

Medications To Treat Ascitis-

  • Diuretics for elimination of excess fluid
  • Antibiotics in case of infections

Surgical Procedures To Treat Ascitis-

  • Paracentesis
    • Remove and aspirate large volumes of fluid
  • Shunt Insertion-
    • Placement of a shunt in the abdomen to facilitate blood flow4
  • Liver Transplant
    • In case if an individual has end-stage liver disease, then liver transplant is required.

Complications Of Ascites

  • Infection- Spontaneous bacterial peritonitis
  • Renal failure
  • Weight loss
  • Alteration in mental status
  • Various other complications associated with Cirrhosis of the liver


1. Diagnosis of spontaneous and secondary bacterial peritonitis in patients with hepatic cirrhosis and ascites.

Krastev N1, Djurkov V2, Murdjeva M3, Akrabova P4, Karparova T4, Penkov V4, Kiprin G4, Asenov K4, Krastev N2, Djurkov V2, Murdjeva M3, Akrabova P4, Karparova T4, Penkov V4, Kiprin G4, Asenov K4.

Khirurgiia (Sofiia). 2013;(3):20-5.

2. Cirrhotic ascites review: Pathophysiology, diagnosis and management.

Moore CM1, Van Thiel DH.

World J Hepatol. 2013 May 27;5(5):251-63.

3. Renal failure in ascites secondary to hepatic, renal, and pancreatic disease. Treatment with a LeVeen peritoneovenous shunt.

Wapnick S, Grosberg S, Kinney M, Azzara V, LeVeen HH.

Arch Surg. 1978 May;113(5):581-5.

4. Prognosis assessment of patients with refractory ascites treated with a peritoneovenous shunt.

Nitta H, Okamura S, Mizumoto T, Matsushita H, Nishimura T, Shimokawa Y, Kimura M, Baba H.

Hepatogastroenterology. 2013 Oct;60(127):1607-10.

Written, Edited or Reviewed By:


Last Modified On: November 12, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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