Why are ascites dangerous

Ascites (water belly): symptom of serious illness

With ascites, the waist circumference increases visibly for no other apparent reason.
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Ascites is the medical term for the accumulation of fluid in the free abdominal cavity. The term comes from the Greek and means "ascites". In the case of larger accumulations of fluid, the water in the abdomen appears as a visible water belly and is a symptom of an illness.

At a glance:

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Causes of ascites: Liver cirrhosis as the main trigger

The most common cause of ascites is cirrhosis of the liver. In around 80 percent of cases, this liver disease is responsible for the development of ascites. At around ten percent, malignant tumors (malignancies) are the second most common cause of ascites. Cardiac diseases such as right heart failure or infectious diseases such as tuberculosis are less common.

An overview of the causes of ascites:

  • Portal ascites for example in liver cirrhosis, alcoholic hepatitis (liver damage from alcohol), Budd-Chiari syndrome (thrombosis of the liver vein) or sinusoidal obstruction syndrome (venous occlusive disease)

  • Cardiac ascites for example in the case of heart failure or pericarditis constrictiva (hardening of the pericardium, "armored heart")

  • Malignant ascites For example, in peritoneal carcinoma (cancer of the peritoneum): Mostly it is a matter of settling other tumors (metastases) in the peritoneum or in the liver, for example from the pancreas, stomach or intestines.

  • Inflammatory ascites for example in tuberculosis (infectious disease caused by bacteria), vasculitis (inflammation of the blood vessels) or peritonitis (inflammation of the peritoneum)

  • Pancreatogenic ascites for example in acute or chronic inflammation of the pancreas (pancreatitis)

  • Other diseases such as the nephrotic syndrome (symptom complex that indicates damage to the kidneys and is associated with an extreme loss of protein)

It is normal for the peritoneum to build up small amounts of fluid. The so-called peritoneal fluid even fulfills an important function in the body: It serves as a lubricant that reduces friction between the organs. Fluid from the blood always reaches the tissue via the blood vessels. Normally, these fluids are removed again via the lymphatic vessels, so that there is a balance. For various reasons, however, it is possible that too much fluid may collect in the abdomen. These reasons can be, for example:

  • Portal hypertension (portal hypertension): In cirrhosis of the liver, it is possible that the scarring of the liver tissue obstructs blood flow, increases pressure on the portal vein (vein that transports blood from the abdominal organs to the liver) and fluid is forced out of the vessels into the abdomen. In addition, so-called sodium and water retention in the kidneys can be involved in the development of portal ascites. This is a dysfunction of the water and sodium regulation.

  • Vascular changes: If there is a malignant ascites due to a malignant tumor formation, lymphatic vessels can be narrowed, which means that the fluid can no longer be removed. It is also believed that blood vessels become more permeable and therefore more fluid leaks out of them.

  • Albumin deficiency (hypoalbuminemia): One of the tasks of proteins in the blood is to bind fluids. The body must have sufficient molecules available for this task. If the content of the protein albumin - for example due to the nephrotic syndrome - is reduced, the so-called colloid-osmotic pressure drops and the fluid can no longer be bound. As a result, it is pressed into the surrounding tissue.

Symptoms of ascites: When the waist size increases visibly

If small amounts of ascites accumulate, this is usually not noticed. With larger amounts, however, there is a noticeable increase in the waist circumference. This must be distinguished from general weight gain due to increased calorie intake or from a briefly bloated stomach after eating, which quickly disappears on its own and can indicate a digestive disorder.

With ascites, accompanying symptoms such as a feeling of pressure in the abdomen, loss of appetite, abdominal pain, vomiting, nausea, weakness or fatigue can occur. An umbilical hernia (umbilical hernia) is also possible. In some severe cases, ascites is also noticeable as shortness of breath.

If symptoms such as weight loss, fever or night sweats occur, these can be signs of cancer as the underlying disease. Ascites is rarely the first or only symptom of cancer.

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Diagnosis: how does the doctor diagnose ascites?

Anyone who already suffers from an underlying disease such as cirrhosis of the liver or cancer should consult a doctor if they suspect ascites. The following methods can be used for diagnosis:

  • anamnese: The doctor tries to find out more about the history in a conversation. For example, he asks whether there are any other symptoms or how much alcohol is consumed.

  • Physical examination: The doctor feels the stomach. When tapping, he makes noises that allow him to recognize the ascites.

  • Ultrasound examination (sonography): This examination can confirm the suspicion of ascites. Small amounts of ascites that have not yet caused any symptoms can also be seen. Therefore, an ultrasound scan done for a different reason may reveal ascites by accident.

  • Laboratory tests: Urine and blood are examined in the laboratory to check liver and kidney values, among other things.

  • Puncture: During a puncture, a cannula is used to pierce the ascites through the abdominal wall. The purpose of this examination is to take a sample of the ascites and examine it in the laboratory. A puncture is performed both if there is a new ascites and if there is sudden severe pain or fever. In this way, germs can be detected that indicate spontaneous bacterial peritonitis (SBP). This is a life-threatening infection that is suspected to be caused by the presence of intestinal bacteria in the ascites.

If the underlying disease is not known, additional diagnostic procedures are used in addition to these examinations to get to the bottom of the cause of the symptom. For example, the doctor can look out for other signs of cirrhosis of the liver - such as enlarged liver or liver skin signs.

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Treatment of ascites: relieve stressful symptoms

The therapy of ascites depends on the underlying disease. It also depends on how pronounced the ascites is and how long it has existed. Therefore, the treatment is always based on the individual case of illness and is determined by the doctor. Above all, it serves to relieve the unpleasant, highly stressful symptoms of ascites such as feeling of pressure or shortness of breath - the underlying disease is not treated by the ascites treatment.

For example, the following can be considered for ascites treatment:

  • Reduction of the salt intake in the diet: The body absorbs sodium via table salt, which binds water in the body and thus promotes water retention (edema). It can therefore be advised to limit the intake of salt. Table salt is mainly found in ready meals, but also in various types of sausage and cheese. Further dietary recommendations can also play a role in the therapy, depending on the individual case - for example a sufficient protein diet, a diet rich in potassium or a reduction in the amount of drink.

  • Medication: In order to increase the excretion of water and table salt in cirrhosis of the liver, for example, dehydrating drugs (diuretics) can be used. The doctor decides exactly how the therapy is carried out: Instead of making the ascites disappear completely, he can only aim for a significant reduction, for example, in order to prevent undesirable side effects from an overly aggressive diuretic therapy.

  • Paracentesis: In paracentesis, a tube is inserted into the ascites during a puncture. Either an ascites sample can be taken for diagnostic purposes or larger amounts of fluid can be drained off to relieve symptoms such as feeling of pressure in the abdomen.

  • Treatment of the underlying disease: In addition, the underlying disease, which is the cause behind the ascites, is treated. For example, this can be chemotherapy in the case of cancer and a liver transplant in the case of liver cirrhosis.

Complications and prognosis: life expectancy with ascites

If the water in the abdomen indicates a serious, progressive disease, the prognosis for ascites is unfortunately poor. Malignant ascites, for example, is a sign that a tumor has already metastasized, which makes the chances of recovery more difficult. If the liver has advanced cirrhosis, a liver transplant is the only way to cure it.


However, ascites treatment is important: the quality of life can be improved by alleviating the symptoms and possible complications can be avoided. Despite therapy, it is possible that the ascites will recur if the underlying disease persists. In order not to have to repeatedly repeat the puncture, permanent solutions such as a permanent drainage system or an indwelling catheter can be used.

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of ascites. Severe abdominal pain and fever can be signs of such an infection and should be investigated immediately by a doctor. The infection can be treated by giving antibiotics - if left untreated, it is usually fatal.

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