Water in the abdomen, ascites - what are its most common causes?

Ascites (water in the abdomen) is a condition of unnatural accumulation of fluid in the abdominal cavity.

More accurately and technically, it is loose fluid in the peritoneal cavity.

The peritoneal cavity is the space in the abdomen that encloses the peritoneum.
The peritoneum is a fine, smooth, and shiny serous membrane.
It covers the organs and is loosely attached to the wall of the abdominal and pelvic cavities.

The peritoneal cavity contains most of the organs of the abdominal cavity and the cranium of the intestine.

Even under normal conditions, some small amount of fluid may be present in the peritoneal cavity. In women, due to hormonal changes during the menstrual cycle, approximately 20 ml balances.

As a maximum and the norm, a content of up to 150 ml is stated.

Amount of fluid in the abdomen above 150 ml = ascites.

Water in the abdomen is a symptom of another disease.

What does water in the abdomen mean and how does it manifest itself?
Is it liver problems and can cardiovascular disease be behind it?
Is it also related to cancer?
Does it have any complications and risks?
These and other information can be found in the article.

The redistribution and management of fluids in the human body is strictly governed by several complex mechanisms.

Professionally, ascites is referred to as a disturbance in the balance of Starling forces. Fluid leaks into the extravascular space (space outside the blood vessels) based on a pathological condition, and the lymphatic system is unable to balance and correct this condition.

Ascites occurs in various liver diseases. It is usually a symptom of chronic diseases.

The formation of ascites can take a long time, but it can also form very quickly.

Especially with the aggravation of a pre-existing long-term disease, the water in the abdomen can increase rapidly.

Therefore, careful monitoring of abdominal girth and body weight is important.

Several litres of water can accumulate in the abdominal cavity during this morbid fluid collection. There are also cases where the abdomen grows by up to 20 litres (massive ascites).

In addition to this huge increase in volume, there is also an increase in weight.

Then it also brings with it other health complications. Examples are problems with walking, abdominal pain or difficulty breathing as the diaphragm is compressed.

Want to know more about abdominal water?
What are the main causes?
It's not just liver disease that's to blame.
What other problems does it bring with it?
Read on with us.

How ascites is caused

Water in the abdomen accumulates through several complex mechanisms. These cause other medical conditions.

Disease + imbalance of Starling forces = water in the abdomen.

There are 3 main mechanisms involved in the formation of ascites:

1. decrease in plasma oncotic pressure
   • decrease in plasma protein
   • the condition is referred to as hypoalbuminemia
2. irritation of the peritoneum
   • The peritoneum is susceptible to fluid leakage following irritation
   • infections
   • after trauma
   • tumor, cancer
3. increased hydrostatic pressure in the blood vessels
   • venous or lymphatic obstruction
   • thrombosis
   • pressure on blood vessels from the surrounding area
   • portal hypertension, also described in the article liver enlargement

Simply put...

1. In the first case, it is a reduction in the amount of proteins found in the blood. These have, among other things, the task of keeping the fluid in the blood vessels, in the blood.

Low albumin levels occur for several reasons and for various diseases.

Albumin is a blood protein.
This protein maintains the oncotic pressure of the plasma.

Examples are increased protein loss in urine, in kidney dysfunction and disease.

+ It can also be caused by impaired absorption of protein from food.

+ It occurs in starvation and malnutrition.

Everyone is familiar with the image...
of small, starving, emaciated children with big bellies.

2. The peritoneum is a soft and serous membrane that encases the organs of the abdominal cavity and covers the wall of the abdominal and pelvic cavity. It is sensitive to irritation.

When it is irritated, it becomes susceptible to fluid penetration.

This happens when it is mechanically irritated by trauma.
Alternatively, when an infection affects it.
A more serious example is the cancer process of the abdominal cavity and pelvis + spread of other cancers and metastasis in the abdomen.

Peritoneal irritation can also be seen as a hard plank-like abdomen. It can be a symptom of peritonitis (inflammation).

3. Increase in hydrostatic pressure in the blood vessels.

This condition occurs when there is an increase in pressure in the veins that drain blood from the abdominal cavity. It is often associated with portal hypertension.

Portal hypertension is an increase in blood pressure in the portal vein.

Vena portae hepatis = portal vein = portal vein.

It's a large and important vein. It drains blood from the small intestine.

Blood from this area is rich in chemical compounds and nutrients that have been absorbed in the small intestine. The vein leads it to the liver where further processing occurs.

It is formed by the union of three larger veins, namely the splenic vein (vena splenica) and the superior and inferior circumflex veins (vena mesenterica superior and inferior).

Blood passes from the portal vein to the liver.

If the liver tissue is damaged, the blood pressure in this system rises.

You probably already know what this hypertension indicates...

One of the most well-known liver diseases is cirrhosis. Cirrhosis is very often caused by alcoholism.

Portal hypertension can also be caused by other diseases such as tumor and cancer of the liver or gallbladder, but also by thrombosis.

Several types of ascites are known.

Ascites can be divided into two types, according to the mechanism either arises:

• exudate - formed during inflammation as an inflammatory effusion
• transudate - due to fluid permeation, as a non-inflammatory effusion
  • violation of the balance between oncotic and hydrostatic pressure
  • fluid pushed out of the blood plasma outside the blood vessels

Classification of ascites based on clinical manifestations:

1. ascites detectable on imaging - USG/SONO
2. minor ascites detectable on physical examination
3. tension ascites - massive abdominal swelling due to the amount of fluid

Ascites and other diseases

The accumulation of water in the abdomen causes liver disease, inflammation of the abdominal organs, oncological process in the area, but also heart disease.

The most common cause of liver disease

The liver is popularly referred to as the detoxification center and chemical factory of the human body. Waste products of metabolism and the activity of the body's cells are directed here. Substances that have been absorbed in the intestine are further processed here.

Their activity is irreplaceable. Like other organs, they are subject to pathological processes and diseases.

Among the best known are acute and chronic inflammations(hepatitis), which can have various causes. The liver is damaged by excessive and prolonged alcohol consumption, intoxication with drugs or certain mushrooms.

Liver cells are able to regenerate and repair themselves until cirrhosis occurs, which indicates irreversible damage.

Another serious disease is liver cancer.

The most serious liver diseases are listed in the table below.

Water in the abdomen for other diseases

In addition to serious liver diseases, ascites also occurs for other causes.

Extrahepatic causes of ascites in the table

What other symptoms may occur?

Ascites of minor extent may not cause any health problems. Alternatively, it has only a mild course.

It is reported to have a mild course when the fluid content in the abdomen is between 100 and 400 ml.

At higher volumes, the abdominal girth increases, as does the body weight. The abdomen may be sore, tight. Indigestion and lack of appetite are added.

Massive ascites presses on the surroundings and compresses the diaphragm. This causes shallow and rapid breathing and even a subjective feeling of lack of air. The fluid may even permeate the pleural cavity and pleural effusion (fluid around the lungs) is produced.

Manifestations that may accompany ascites include:

• Fatigue
• weakness
• lack of appetite
• dyspepsia and a feeling of heaviness in the stomach, digestive problems
• abdominal pain and discomfort in the abdomen, discomfort
• weight gain
• swelling of the body, from the legs, abdomen, upper limbs, through the face and all over the body (anasarca)
• the abdomen is large
  • skin tight
  • stretch marks may occur
  • flat or even bulging navel
• bloating and flatulence
• feeling of a full belly
• difficulty breathing - pressure of the abdominal cavity on the diaphragm, shallow and rapid breathing
• difficulty walking
• psychological stress
• abdominal hernias
• increase in body temperature to fever - watch out for bacterial inflammation

Complications and prognosis of ascites

Ascites in the abdomen arises from a variety of causes. Depending on the options and adherence to treatment, it also has a prognosis.

The prognosis is poor in cirrhosis of the liver, when there is no longer the possibility of natural regeneration of the liver cells. Liver transplantation is important. However, it also carries various complications and risks.

It is also serious in liver cancer and other oncological diseases.

A better prognosis comes from the treatment of inflammatory diseases and after trauma. Of course, it depends on the extent of the damage.

Therefore, the general prognosis cannot be determined in advance without diagnosis and effective treatment.

It is also necessary to take into account possible complications, and these include:

• Difficulty breathing due to Pickwick's syndrome - swelling of the abdomen presses on the diaphragm, also happens with obesity
• pleural effusion - fluid also enters the pleural cavity
• abdominal hernia - most common complication of larger forms, weakened wall, muscles, abdominal muscles and increased intra-abdominal pressure mean risk of bowel bulging outside the abdominal wall, umbilical hernia is most common
• rupture of ascites - a risk in the massive form, it occurs mainly at the site of the hernia, it is a life-threatening condition
• spontaneous bacterial peritonitis - inflammation of the peritoneum when intestinal bacteria penetrate the weakened intestine
• inflammation of the oesophagus, such as reflux oesophagitis - increased pressure in the abdomen causes prolonged reflux of stomach acid into the oesophagus
• hepatorenal syndrome - kidney failure in liver disease
• haemorrhoids - for increased pressure in the abdominal cavity, also constipation and problem with defecation
• limitation of mobility and disability in large ascites
  • limitation of self-care activities

Can it be treated?

The treatment of ascites at large depends on treating the underlying cause.

Further, the doctor is also guided by the type of ascites.

Before treatment, diagnosis is important. This includes physical examination of the abdomen, mainly by looking, palpation, tapping, measurement of waist circumference, weight.

It is complemented by X-ray, USG (sonography of the abdomen), CT, or MRI. To exclude certain diseases, endoscopic methods are also used.

Laboratory examination of blood is important, but also fluid samples - after puncture of water from the abdomen.

Treatment according to type:

• mild and moderate ascites - conservative, pharmacological treatment
  • restriction of salt, sodium intake
  • administration of diuretics - drugs for drainage, promote urination
• refractory ascites - does not respond to conventional treatment, resort to invasive methods
  • paracentesis - drainage of water from the abdomen = puncture of the abdomen with a needle
    • a needle is inserted into the abdomen under sterile conditions
    • the contents are slowly sucked out
    • maximum 2 litres in 30 minutes
    • there is a risk of complications if the procedure is done quickly
    • Plasma and albumin are infused at the same time
    • Otherwise, hypovolemic shock would be imminent.
  • transjugular intrahepatic portosystemic shunt (vascular shunt between the portal vein and the hepatic vein that enters the inferior vena cava)
  • ascites reinfusion - if the ascites is sterile and not infected, the effusion cavity can connect to the hepatic veins

Paracentesis = therapeutic puncture of the ascites.
This method provides immediate relief as several litres can be removed from the abdomen.

A change in lifestyle, restriction of salt intake, control of fluid intake is necessary.

A complete ban on alcohol is important.