In cirrhosis, scarring of the liver disrupts blood flow and increases pressure in the portal vein, leading to fluid leaking into the abdominal cavity. Ascites can cause abdominal swelling, discomfort, and shortness of breath, and it is a major sign that liver disease has become more advanced or “decompensated.” Ascites can also occur from other conditions, but cirrhosis is the most common cause.
Patients notice increasing abdominal girth, weight gain from fluid, and sometimes ankle swelling or shortness of breath as the fluid pushes up on the lungs.
Call the office if you have known liver disease and notice new or worsening abdominal distension, leg swelling, shortness of breath, or sudden weight gain, or if you already have ascites and develop fever or abdominal pain.
Seek emergency care for severe shortness of breath, sudden severe abdominal pain, confusion, very low urine output, or high fever—these can be signs of serious complications such as spontaneous bacterial peritonitis or kidney failure.
Evaluation includes physical exam, imaging (often ultrasound), lab tests, and usually a procedure called paracentesis to sample the fluid for analysis and to rule out infection.
Management combines treating the underlying liver disease, adjusting diet, using diuretics (water pills), and removing fluid when needed. In advanced cases, more specialized procedures or liver transplant evaluation may be appropriate.
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