CLINACASE

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ID: 243
Category: Gastroenterology and Hepatology
CreatedBy: 1
UpdatedBy: 1
createdon: 17 May 2023
updatedon: 17 May 2023

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Author: Khoa Tran
Published May 17, 2023
Updated May 17, 2023

Table of contents

Ascites

Etymology and Pronunciation

ascites (uh-sahy-teez)
askos - Greek for "bag" or "sack"

History of Ascites

Ascites is a medical condition characterized by the accumulation of fluid in the abdominal cavity. This condition has been known to humans for centuries since it is caused by drinking excess alcohol (liver cirrhosis) and patients present with a distended, fluid-filled stomach.

Historically, people who died of ascites were observed to have an extremely high amount of fluid in their body cavity (specifically, the peritoneal cavity). However, its etiology and treatment remained poorly understood until the medical community developed a better understanding of liver and kidney cells, and the role protein and hormones had on the body.

One of the key discoveries that contributed to our understanding of ascites was the development of modern microscopy. With the invention of the microscope in the 17th century, scientists were able to observe and study the structure of cells and tissues in greater detail than ever before. This allowed them to identify specific changes in the liver, kidney, and other organs that could lead to the development of ascites.

In the 19th century, advances in chemistry and biology led to the identification of proteins and hormones that play a role in regulating fluid balance in the body. Researchers also discovered the importance of the lymphatic system in draining excess fluid from tissues and preventing the accumulation of fluid in the abdominal cavity.

More recently, the development of medical imaging technology such as CT scanning and ultrasound has allowed doctors to visualize the accumulation of fluid in the abdominal cavity and determine the underlying cause. This has led to the development of new treatments for ascites, such as paracentesis, which involves draining the excess fluid from the abdominal cavity using a needle and syringe.

Overall, the discovery of ascites was made possible by a combination of advances in microscopy, chemistry, biology, and medical imaging technology.

Modern Understanding of Ascites

Ascites is the medical term for a condition where there is a buildup of fluid in the abdomen. This may cause the belly to become swollen and look bigger than it normally does. People with ascites may feel uncomfortable and experience a feeling of being full even if they have not eaten anything.

Ascites can be a sign of an underlying health problem, but it can also occur without any known cause. Some conditions that may cause ascites include cirrhosis of the liver, heart failure, and cancer. Ascites may also be due to an infection or inflammation in the abdomen.

Causes of Ascites

Ascites is a condition that can happen due to different diseases, like liver disease, heart failure, kidney problems, infections, or cancer. When someone has cirrhosis, a liver disease caused by long-term hepatitis, it can lead to a complication called portal hypertension. This means there is increased pressure in the portal vein system.

The liver has an important job of filtering certain wastes from the blood. It gets blood from the heart through one route called the hepatic artery, and from the digestive system and pancreas through another route called the portal vein.

When cirrhosis develops, the cirrhotic and nodular liver makes it harder for the portal vein system to filter properly. This causes increased pressure in the blood flowing through the digestive system.

The increased pressure pushes fluid (made of water and proteins) out of the blood vessels, and it collects in the abdominal cavity.

When fluid leaks from the liver, the volume of blood decreases. To compensate for this, the kidneys start to retain sodium, which helps conserve water and maintain the normal blood level - which only causes further ascites.

Treatments for Ascites

There are different treatments available for Ascites, depending on the severity of the condition and the underlying cause. Here are some common treatments for Ascites:

- Medications: In some cases, diuretics or water pills may be prescribed to help reduce the amount of fluid in the body. Antibiotics may also be given to reduce the risk of infection.
- Paracentesis: This is a procedure where a needle is inserted into the abdominal cavity and the excess fluid is drained out. It is usually done in a hospital setting.
- TIPS procedure: In some cases, a transjugular intrahepatic portosystemic shunt (TIPS) procedure may be recommended. This is a minimally invasive procedure where a small tube is inserted through a vein in the neck and guided to the liver. The tube helps divert blood flow around the liver and reduces the amount of pressure in the liver, which can help reduce the build-up of fluid in the abdomen.
- Surgery: If the Ascites is caused by a medical condition that cannot be treated with other methods, such as cancer, surgery may be required to remove the tumor or other affected area.

Lifestyle Changes

- Alcohol avoidance: If the underlying cause of ascites is alcohol-related liver disease, it is essential to completely abstain from alcohol. Alcohol can worsen liver damage and contribute to fluid accumulation.
- Maintain a healthy weight: Achieving and maintaining a healthy weight is important for managing ascites. Excess weight can put additional strain on the liver and worsen fluid retention. Follow a balanced diet and engage in regular physical activity to achieve a healthy weight.
- Regular exercise: Engaging in regular physical activity, as tolerated and advised by your healthcare provider, can improve overall health and reduce fluid retention. Choose low-impact exercises, such as walking or swimming, to minimize strain on the body.
- Compliance with prescribed medications: Take all medications as prescribed by your healthcare provider. These may include diuretics or medications to manage the underlying cause of ascites. Follow the recommended dosage and schedule.
- Frequent medical follow-ups: Regularly visit your healthcare provider for check-ups and monitoring of your condition. They can assess your progress, adjust medications if needed, and provide necessary guidance.

Nutrional Changes

- Limit sodium intake: Consuming less sodium is crucial in managing ascites. Sodium can contribute to fluid retention in the body. Avoid high-sodium foods such as processed and packaged foods, fast food, canned soups, and salty snacks. Instead, opt for fresh, whole foods and flavor meals with herbs, spices, and other low-sodium seasonings.
- Follow a low-fluid diet: Depending on the severity of ascites and your healthcare provider's recommendations, you may need to restrict fluid intake. This helps control the accumulation of fluid in the body. Your healthcare provider will provide specific guidelines on the amount of fluid you should consume each day, including beverages and foods with high water content.
- Moderate fluid and salt intake: While fluid restriction is important, it is essential to maintain adequate hydration. Monitor your fluid intake and opt for small, frequent sips of fluids throughout the day. Additionally, be mindful of hidden sources of sodium, such as condiments, sauces, and processed foods.
- Eat smaller, frequent meals: Consuming smaller, more frequent meals can help alleviate pressure on the digestive system and reduce discomfort. This approach can also prevent overeating and excessive fluid accumulation.
- Limit alcohol consumption: If the underlying cause of ascites is alcohol-related liver disease, it is crucial to completely avoid alcohol. Alcohol can worsen liver damage and contribute to fluid retention.
- Seek professional guidance: Consult a registered dietitian or healthcare provider who can provide personalized dietary recommendations based on your specific needs and medical condition. They can help create a tailored meal plan that addresses your nutritional requirements and assists in managing ascites.

Symptoms

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Abdominal swelling and distension
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Reduced urine output and frequency
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Abdominal pain
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Yellowing of skin and eyes (jaundice)
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Swelling in the legs, ankles, or abdomen
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Weight gain
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Heartburn
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Shortness of breath
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Difficulty breathing

Confirmation Tests

- Physical examination
- Ultrasound
- CT scan
- MRI
- Blood test (for Albumin level)
- Paracentesis

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