Ascites: Causes, Implications, and Treatment Options

Q: Ascites: Causes, Implications, and Treatment Options

Hello, Miss： In the advanced stages of cirrhosis (and liver cancer), ascites may occur, requiring long-term diuretic therapy along with restrictions on fluid and salt intake. <br>If liver function (such as ascites or jaundice) continues to deteriorate, then transarterial emboliza

The effects of ascites on the body?

My father is 56 years old.
In 1993, a tumor was discovered in his liver, and he has been receiving follow-up treatment at Chang Gung Memorial Hospital in Chiayi, including embolization therapy five to six times.
Since the end of March this year, he has experienced abdominal distension, and tests indicated the presence of ascites.
The doctor prescribed diuretics, which he has been taking, but he often feels discomfort in his throat, although the ascites subsides.
If he stops taking the medication, the ascites reappears.
In late April, he was hospitalized; although embolization was initially planned, the doctor stated that the tumor had not increased in size, so it was not necessary.
At that time, he also reported gastric discomfort, and an endoscopy revealed a gastric ulcer.
After starting medication for the ulcer, his discomfort has lessened.

I would like to ask what causes the formation of ascites? If the tumor has not increased in size, why is there ascites? Is the recurrent ascites a sign of worsening liver disease, or could it indicate the potential for more severe conditions in the future? (Currently, my father’s daily life is normal; he is retired and not working.) Is long-term use of diuretics harmful to the body, such as causing damage to other organs? What further recommendations do you have for treating his liver condition? Thank you!

Wulong Tea, 20~29 year old female. Ask Date: 2007/05/22

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Miss: In the advanced stages of cirrhosis (and liver cancer), ascites may occur, requiring long-term diuretic therapy along with restrictions on fluid and salt intake.
If liver function (such as ascites or jaundice) continues to deteriorate, then transarterial embolization should not be performed to avoid severe complications.
Changhua Hospital is concerned about your health.
Chen Shidian

Reply Date: 2007/05/22

More Info

Ascites is a medical condition characterized by the accumulation of fluid in the abdominal cavity. It is often associated with liver disease, particularly cirrhosis, but can also occur due to other conditions such as heart failure, malignancies, or infections. In your father's case, the presence of ascites following a history of liver tumors suggests that his liver function may be compromised, even if the tumors themselves have not increased in size.

Causes of Ascites
The primary cause of ascites in patients with liver disease is portal hypertension, which is increased pressure in the portal venous system due to liver scarring (cirrhosis). This pressure forces fluid out of the blood vessels and into the abdominal cavity. Other potential causes of ascites include:
1. Malignancy: Tumors can cause ascites either by blocking lymphatic drainage or by producing fluid directly.

2. Infections: Conditions like spontaneous bacterial peritonitis can lead to fluid accumulation.

3. Heart Failure: Congestive heart failure can lead to fluid retention and ascites.

4. Kidney Disease: Conditions affecting kidney function can also contribute to fluid buildup.

Implications of Ascites
The presence of ascites can indicate worsening liver function and may lead to complications such as infection (e.g., spontaneous bacterial peritonitis), abdominal compartment syndrome, or respiratory difficulties due to pressure on the diaphragm. It is crucial to monitor ascites closely, as its recurrence can signal progressive liver disease.

Treatment Options
The treatment for ascites typically involves:
1. Diuretics: Medications like spironolactone and furosemide are commonly prescribed to help the body eliminate excess fluid. However, as you mentioned, your father has experienced discomfort in his throat while taking diuretics. This could be due to electrolyte imbalances or other side effects, and it is essential to discuss these symptoms with his physician to adjust the treatment plan if necessary.

2. Paracentesis: This procedure involves the removal of excess fluid from the abdominal cavity using a needle. It can provide immediate relief from symptoms of discomfort and pressure.

3. Dietary Changes: A low-sodium diet can help manage fluid retention.

4. Management of Underlying Conditions: Addressing the underlying cause of ascites, such as controlling liver disease or treating infections, is crucial.

Concerns About Long-term Diuretic Use
Long-term use of diuretics can lead to potential side effects, including:
- Electrolyte Imbalances: Diuretics can cause low potassium (hypokalemia) or low sodium (hyponatremia), which can lead to muscle weakness, fatigue, and other complications.

- Kidney Function: Overuse of diuretics can strain the kidneys, especially in patients with pre-existing kidney issues.

- Dehydration: Excessive fluid loss can lead to dehydration, which can exacerbate kidney problems and other health issues.

Recommendations for Liver Health
Given your father's history of liver tumors and current symptoms, it is essential to maintain regular follow-ups with his healthcare provider. Recommendations may include:
1. Regular Monitoring: Routine imaging and blood tests to monitor liver function and tumor status.

2. Lifestyle Modifications: A balanced diet, regular exercise (as tolerated), and avoiding alcohol can help support liver health.

3. Medication Review: Regularly review all medications with his healthcare provider to ensure they are appropriate and to manage any side effects effectively.

In conclusion, while ascites can be a concerning symptom, it is manageable with appropriate medical care. Continuous communication with healthcare providers is vital to ensure your father receives the best possible treatment and support for his condition.

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