When Peritoneal Fluid Becomes Ascites in Hepatitis Patients

The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.. Photo © A.D.A.M.

Peritoneal fluid is a normal, lubricating fluid found in the peritoneal cavity -- the space between the layers of tissue that line the belly's wall and the abdominal organs (such as the liver, spleen, gall bladder, and stomach). The fluid is mostly water with electrolytes, antibodies, white blood cells and other biochemicals.

What Is the Purpose of Peritoneal Fluid?

The primary function of peritoneal fluid is to reduce the friction between the abdominal organs as they move around during digestion.

 In a healthy person, there is normally a small amount of peritoneal fluid present in the peritoneal cavity. However, some problems in the body can cause excess fluid to accumulate in the cavity. This fluid is called ascitic fluid and leads to ascites, one of the complications of cirrhosis.

How Does Ascites Develop?

Ascites is most common in patients who have diseases affecting the liver. Damage to the liver can cause high blood pressure in the veins that deliver blood to the liver, a condition known as portal hypertension. However, many other disorders can cause ascites as well, including cancer, heart failure, kidney failure, inflammation of the pancreas (pancreatitis), and tuberculosis affecting the lining of the abdomen. 

Symptoms of Ascites

When the condition is mild, there may be no noticeable symptoms. However, when moderate amounts of fluid are present in the abdomen, a person may notice his or her waist size has increased and he or she may have gained weight.

Larger amounts cause even more symptoms, including swelling of the abdomen and discomfort. In these patients, the abdomen may feel tight and stretched, as in a pregnancy, and the bellybutton may begin to protrude. 

When ascites reaches an advanced level, swelling in the abdomen puts pressure on the stomach, which can lead to appetite loss, as well as the lungs, which can lead to shortness of breath.

Some patients notice swelling in other areas of the body as well, such as the ankles. 

A complication of ascites, bacterial peritonitis, is an infection that can cause abdominal discomfort and tenderness as well as fever and malaise. Confusion, disorientation, and drowsiness can develop and, if untreated, this condition can be fatal. 

Diagnosing Ascites

Usually, a history and physical performed by your doctor will be enough to raise suspicion of ascites. To confirm the diagnosis, an ultrasound or CT scan may be ordered. And a small sample of ascitic fluid can be analyzed by withdrawing it through a needle inserted into the wall of the abdomen. This procedure is called diagnostic paracentesis. 

Treating Ascites

Treating ascites begins with a diet low in sodium and bed rest. When those strategies are not sufficient, a doctor may prescribe the use of diuretics to help the kidneys excrete more sodium and water into the urine.

For patients who experience significant discomfort or those who cannot breathe or eat without difficulty, fluid may be removed through a procedure called therapeutic paracentese, in which a needle is inserted into the abdomen.

In rare cases, surgery is performed to reroute blood flow using a shunt and, in the rarest cases, liver transplantation is necessary. 

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