Ascites

  • Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Ascites Facts

  • Ascites refers to abnormal accumulation fluid in the abdominal (peritoneal) cavity.
  • The most common cause of ascites is cirrhosis of the liver.
  • Treatment of ascites depends on its underlying cause.

What is ascites?

Ascites is the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) that accumulates in the abdominal (peritoneal) cavity. The abdominal cavity is located below the chest cavity, separated from it by the diaphragm. Ascitic fluid can have many sources such as liver disease, cancers, congestive heart failure, or kidney failure.

What causes ascites?

The most common cause of ascites is advanced liver disease or cirrhosis. Although the exact mechanism of ascites development is not completely understood, most theories suggest portal hypertension (increased pressure in the liver blood flow to the liver) as the main contributor. The basic principle is similar to the formation of edema elsewhere in the body due to an imbalance of pressure between inside the circulation (high pressure system) and outside, in this case, the abdominal cavity (low pressure space). The increase in portal blood pressure and decrease in albumin (a protein that is carried in the blood) may be responsible in forming the pressure gradient and resulting in abdominal ascites.

Other factors that may contribute to ascites are salt and water retention. The circulating blood volume may be perceived as low by the sensors in the kidneys as the formation of ascites may deplete some volume from the blood. This signals the kidneys to reabsorb more salt and water to compensate for the volume loss.

Some other causes of ascites related to increased pressure gradient are congestive heart failure and advanced kidney failure due to generalized retention of fluid in the body.

In rare cases, increased pressure in the portal system can be caused by internal or external obstruction of the portal vessel, resulting in portal hypertension without cirrhosis. Examples of this can be a mass (or tumor) pressing on the portal vessels from inside the abdominal cavity or blood clot formation in the portal vessel obstructing the normal flow and increasing the pressure in the vessel (for example, the Budd-Chiari syndrome).

Ascites can also manifest as a result of cancers, called malignant ascites. This type of ascites is typically a manifestation of advanced cancers of the organs in the abdominal cavity, such as, colon cancer, pancreatic cancer, stomach cancer, breast cancer, lymphoma, lung cancer, or ovarian cancer.

Pancreatic ascites can be seen in people with chronic (long standing) pancreatitis or inflammation of the pancreas. The most common cause of chronic pancreatitis is prolonged alcohol abuse. Pancreatic ascites can also be caused by acute pancreatitis as well as trauma to the pancreas.

Medically Reviewed by a Doctor on 2/24/2016
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