Ascites is the build up of an abnormal amount of fluid inside the abdomen (belly). This is a common problem in patients with cirrhosis of the liver.When the liver malfunctions,fluid fills the space between the abdominal lining and the organs. Approximately 80% of patients with cirrhosis of the liver develop ascites.When more than 25ml of fluid builds up inside the abdomen, it is known as ascites.
Traditionally, ascites is divided into types –
This classification is based on the amount of protein found in the fluid.
A more useful system has been developed based on the amount of albumin in the ascitic fluid compared to the serum albumin.This is called the Serum Ascites Albumin Gradient os SAAG.
Ascites related to portal hypertension is generally greater than 1.1 and ascites caused by other reasons (malignant, pancreatitis) is lower than 1.1
There may be no symptoms associated with ascites especially if it is mild. As more fluid accumulates,increased abdominal girth and size are commonly seen.
Some common symptoms that appear due to ascites includes –
• Abdominal pain
• Shortness of breath due to increased pressure on the diaphragm
• Disfigured belly
• Swelling in legs and ankles
• Fast weight gain
Ascites is most often caused by liver scarring, otherwise known as cirrhosis. Scaring increases pressure inside the liver’s blood vessels. The increased pressure can force fluid into the abdominal cavity, resulting in ascites.
Risk factors –
Liver damage is the single biggest risk factor for ascites. Some causes of liver damage includes –
• hepatitis B or C
• a history of alcohol abuse
Other conditions that may increase your risk for ascites includes-
• ovarian, pancreatic, liver or endometrial cancer
• heart or kidney failure
• Abdominal pain
• Pleural effusion or water on the lung, this can lead to difficulty breathing
• Hernias, such as inguinal hernias
• Bacterial infections, such as spontaneous bacterial peritonitis (SBP)
• Hepatorenal syndrome, a rare type of progressive kidney failure
Diagnosing ascites takes multiple steps.Your doctor will first check for swelling in your abdomen.
Then they will probably use imaging or another testing method to look for fluid. Tests you may be advised includes –
• CT scan
• Blood tests
Treatment of ascites will depend on what’s causing the condition.
• Diuretics –
Diuretics or commonly called as water pills such as frusemide, spironolactone are used to treat ascites and are effective for most people with the condition. These drugs increase the amount of salt and water leaving your body, which reduces pressure within the veins around the liver. While on diuretics, you will probably need to reduce your alcohol use and salt intake.
• Paracentesis –
In this procedure, a thin, long needle is used to remove the excess fluid. It is inserted through the skin and into the abdominal cavity. There is a risk of infection, so people who undergo paracentesis may be prescribed antibiotics.
• Surgery –
In extreme cases, a permanent tube called a shunt is implanted in the body. It reroutes blood flow around the liver.
Ayurvedic Perspective –
In Ayurveda, ascites is known as Jalodara. As per Ayurveda, jalodara is a type of udara roga, which is caused due to the accumulation of malas (waste products).This accumulated waste leads to the vitiation of doshas, prana vata, agni and apana vata.The main aim of treatment is the removal of the waste from the abdomen. This is acheived by nitya mridu virechana (regular use of mild purgatives).
Beneficial Herbs –
• Punarnava –
• Haritaki –
• Pippli –
• Milk thistle –
• Dandelion –
• Jalodarari Ras
• Purarnava Mandur
• Aarogyavardhini Vati
• Shveta parpati
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