Is Ascites Always a Sign of Cirrhosis in Chronic Hepatitis C Patients?

If my mother has hepatitis C, does the presence of ascites necessarily indicate cirrhosis?

Hello, doctor.
My mother had slightly elevated hepatitis C levels three months ago.
However, she underwent blood tests, ultrasound, and fetal protein tests at the hospital, all of which were normal.
The doctor mentioned that there were no signs of liver cirrhosis and that her kidneys were functioning well, but there was some ascites in her abdomen of unknown origin, and an MRI was recommended.
Unfortunately, we did not follow up on that.
Recently, the ascites has increased significantly.
I have researched a lot online, but my mother does not exhibit many symptoms of liver cirrhosis or liver cancer, such as jaundice, pain, spider angiomas, or prominent abdominal skin vessels.
Many of the symptoms listed online are absent.
Currently, my mother feels bloated, has some cough, and occasionally experiences back pain due to her enlarged abdomen.
Interestingly, her previously swollen legs have improved, and her complexion remains good without any yellowing of the skin.
Although her appetite is not as good as before, we suspect it might be due to the pressure from the ascites on her gastrointestinal tract.
She does not have frequent bowel movements, but she is still able to pass stool, and both her urine and stool colors are normal.
The only issue is that the ascites has not resolved despite taking diuretics.
Could this be a problem related to her liver? Is it possible that the ascites is simply due to a deficiency of albumin in her liver? We had an MRI last week, but the report has not come out yet, and I am really worried.

Wayne, 20~29 year old female. Ask Date: 2020/03/24

Dr. Chen Shidian reply Gastroenterology and Hepatology

Cooperate with the gastroenterology outpatient clinic for diagnosis, follow-up, and treatment.
Simple initial-stage cirrhosis with ascites is not difficult to manage; please follow the physician's medication regimen and limit salt intake.

Reply Date: 2020/03/24

More Info

Ascites, or the accumulation of fluid in the abdominal cavity, is a condition that can arise from various underlying causes, and while it is commonly associated with liver cirrhosis, it is not exclusively indicative of it, especially in patients with chronic Hepatitis C. In your mother's case, the presence of ascites without other classic signs of liver cirrhosis or liver cancer, such as jaundice, spider angiomas, or significant abdominal pain, suggests that further investigation is warranted to determine the underlying cause.

Chronic Hepatitis C can lead to liver damage over time, and in some cases, it can progress to cirrhosis. However, not all patients with chronic Hepatitis C will develop cirrhosis, and the presence of ascites can also be due to other factors. For instance, ascites can occur due to portal hypertension, which is an increase in blood pressure in the portal venous system, often caused by liver scarring. However, ascites can also result from conditions such as heart failure, kidney disease, or even malignancies unrelated to the liver.

In your mother's situation, the fact that her liver function tests were normal and that imaging studies did not show signs of cirrhosis is reassuring. The ascites could potentially be related to a transient condition, such as a mild infection, inflammation, or even dietary factors leading to low protein levels in the blood, which can decrease oncotic pressure and lead to fluid accumulation. Low albumin levels, which can occur in liver disease or malnutrition, can indeed contribute to the development of ascites.

Given that your mother has experienced an increase in abdominal fluid and has been prescribed diuretics without significant improvement, it is crucial to follow up with the healthcare provider for further evaluation. The MRI results will provide additional insights into the cause of the ascites. It is essential to rule out any serious conditions, including malignancies or significant liver pathology.

In summary, while ascites can be a sign of cirrhosis in chronic Hepatitis C patients, it is not definitive on its own. The absence of other symptoms typically associated with advanced liver disease is a positive sign. It is important to continue monitoring her condition and to work closely with her healthcare team to determine the underlying cause of the ascites and to develop an appropriate management plan. Regular follow-ups and imaging studies will be key in ensuring her health and addressing any potential complications early on.

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