How does cirrhosis lead to ascites

Ascites

Ascites(Ascites): Fluid build-up in the abdominal cavity. Ascites is usually the sign of an advanced disease with a poor prognosis; In 75% of cases, cirrhosis of the liver is the cause. The amount of liquid in the accumulated water can be enormous and well over ten liters. The first thing the patient notices is an increase in waist size; Pants and belt no longer fit. Later the ascites leads to feelings of pressure and nausea, sometimes even to shortness of breath. To relieve the discomfort, doctors try to reduce the abdominal fluid. It is treated with diuretics, punctures and shunts.

Leading complaints

  • Sudden increase in waist size
  • Feeling of pressure
  • Nausea, vomiting, heartburn
  • Difficulty breathing with massive ascites
  • Umbilical hernia
  • Often associated with other water retention, e.g. B. on the lower legs.

When to the doctor

In the next few days at

  • Steadily increasing waist size
  • Shortness of breath
  • Feeling of pressure in the stomach.

The illness

Disease emergence

With ascites, fluid, often with cells, blood components and protein, gets into the abdominal cavity. The reasons for this are very different:

  • Portal hypertension. For example, if the pressure in the veins in the abdomen increases, fluid "pushes" out of the vessels into the abdominal cavity. This happens e.g. B. when the blood builds up in the portal vein (portal vein hypertension). Such an increase in pressure in the portal vein occurs primarily in liver cirrhosis and liver cancer, but also in right heart failure or portal vein thrombosis.
  • cancer. If the lymph drainage is blocked - e.g. B. due to malignant tumors and metastases on the peritoneum (peritoneal carcinosis) - less fluid and lymph is absorbed from the abdomen. Malignant tumors actively "sweat" water into the abdominal cavity themselves, and tumor cells are often found in the ascites. In addition, malignant tumors often produce proteins that stimulate the formation of new blood vessels. These new blood vessels are often particularly permeable, which in turn causes more fluid to enter the abdomen.
  • Protein deficiency. If the protein content in the blood decreases, water migrates from the blood vessels into the abdominal cavity. This is e.g. This is the case, for example, with liver dysfunction with reduced protein production (cirrhosis of the liver), with malnutrition, hunger and anorexia. Other causes are protein losses in kidney or intestinal diseases.
  • Inflammation. If there is inflammation in the abdomen, blood flow increases and the cell walls become more permeable. As a result, fluid and often inflammatory cells get into the abdominal cavity. This mechanism plays e.g. B. a role in peritonitis or acute pancreatitis.

clinic

Due to the mechanisms described above, fluid increasingly accumulates in the abdomen. At first, the patient usually does not notice the ascites. If it becomes several liters, the waist circumference and weight increase and items of clothing no longer fit. Often the depression of the navel flattens out; occasionally there is an umbilical hernia. With large amounts of fluid in the abdomen, people suffer from pressure, nausea, and heartburn. If the abdominal fluid pushes the diaphragm upwards, there is also shortness of breath.

Diagnostic assurance

Ascites can be easily and reliably determined with the help of an abdominal ultrasound. It is more difficult to find the cause of the ascites. The doctor therefore often punctures a newly formed ascites in order to analyze its composition and thus find out the origin of the fluid. The doctor looks in the ascites z. B. for proteins, red and white blood cells, tumor markers, tumor cells or bacterial pathogens.

In addition to physical examination and analysis of the punctured ascites, the doctor uses laboratory tests and imaging methods to track down the actual underlying disease such as cancer, cirrhosis or heart failure.

Differential diagnoses. An increased waist circumference is also the symptom of increased air in the gastrointestinal tract (meteorism, e.g. in intestinal diseases such as celiac disease or lactose intolerance), obesity and pregnancy.

treatment

The most important treatment measure is the therapy of the underlying disease, e.g. B. by the doctor delaying the progression of cirrhosis, surgically removing a tumor or treating an inflammation.

Treatment of the ascites

To relieve the discomfort caused by ascites itself, doctors try to reduce the amount of fluid in the abdomen. There are various methods of doing this.

Basic measures. Depending on the composition and cause of the ascites, control of the salt and fluid intake is necessary. Then the patient may not drink more than 1.5 liters of liquid and consume 5 g of salt per day. To control water retention, the patient must also weigh himself daily.

Diuretics. Doctors use diuretics to flush the fluid out of the body through the kidneys. Here he often uses spironolactone, in some cases also combined with furosemide. During therapy with diuretics, the doctor closely checks the kidney values ​​as well as sodium and potassium in the blood, as these can change due to medication.

Ascites puncture. If the treatment with diuretics is insufficient, the doctor will draw off the liquid with a cannula or hollow needle. In this way, 0.5-1.5 liters are removed per puncture, which the patient immediately perceives as a relief. B. in the reduction of pain through the reduced abdominal tension and improvement of the shortness of breath.

Permanent drainage system. If ascites continues to run into the abdominal cavity despite the puncture, the doctors also alleviate the symptoms by draining the ascites outwards through a plastic catheter. The catheter is attached to the abdominal wall with a plaster. Then you connect a tap through which the patient can control the drainage of the liquid himself.

Portocaval Shunt. With ascites due to portal hypertension, a portocaval shunt can help in some cases. Doctors connect the portal vein with the inferior vena cava and direct the blood past the liver. This bypasses the area with restricted flow, the blood can flow better again and less water is pressed into the abdominal cavity. The disadvantage is that the diverted blood is no longer detoxified and there is therefore a risk of hepatic encephalopathy.

forecast

Unfortunately, the prognosis is usually poor: in most cases, ascites is a sign of the progression of a serious disease. If ascites occurs in patients with liver cirrhosis, every second person dies within the next 2 years.

Your pharmacy recommends

What you can do yourself

  • Stick to the recommended drinking quantities to control your hydration. Usually an amount of 1.2-1.5 l / day is recommended. When calculating fluids, add soups, sauces and yoghurts.
  • The following tips help against thirst:
    • Drink from small, narrow glasses.
    • Don't use extra salt in your food.
    • Avoid sweet foods, they too make you thirsty.
    • Wet the oral cavity with oral spray.
    • Sour things like lemon, lime or vinegar act as thirst quenchers.
    • Breathe through your nose instead of your mouth.
    • Avoid dry room air.
  • Rest for 4-5 hours during the day. When lying down, more water is excreted via the kidneys, so it can collect less in the body.
  • Weigh yourself daily and record your weight.
  • Contact your doctor if your waist circumference and / or weight gain.
  • Diuretic drugs sometimes cause low blood pressure, severe dry mouth, nausea and vomiting, fatigue, and muscle weakness. Contact your doctor if you experience these symptoms. Sometimes the dose of diuretics has to be adjusted or the preparation has to be changed.

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 09:19


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.