Causes and risk factors
It is a common complication of liver cirrhosis. Liver cirrhosis gives rise to portal hypertension. As a result, there is release of local vasodilator, which affects the splanchnic arteries. Thus, there is fall in arterial blood flow and arterial blood pressure. Progressive vasodilation leads to activation of vasoconstrictor and antinatriuretic mechanisms. Ultimately, there is sodium and water retention.
Clinical presentation
Ascites may be minimum [grade I], moderate [grade II], severe [grade III] or tensed [grade IV]. Abdominal distension is observed. Patient complains of diffuse abdominal pain and tenderness. There is shortness of breath when lying down. Patient experiences bloating, diminished appetite, sudden weight gain, nausea, vomiting, and heartburn. Signs of fluid accumulation in abdomen such as bulging of the flanks is seen. On physical examination, shifting dullness [difference in percussion notes which shifts when patient turns on other side] and fluid thrill [tapping on one side of abdomen will create a wave like effect which is felt on other side of abdomen] are observed.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Ascitic fluid tapping and examination is recommended. Diagnostic paracentesis includes measurement of ascitic fluid for protein, neutrophil count, and amylase. The normal values of ascitic fluid (straw coloured appearance of fluid) are – specific gravity < 1.016, protein < 25 g/dL, RBC 1%, WBC < 250/mm3. Ascitic fluid cytology may be advised to rule out malignancy. USG abdomen is done. Blood tests include serum urea, electrolytes, CBC, prothrombin time, and LFT.
Treatment
Treatment depends upon the underlying cause, i.e., liver cirrhosis. Treatment aims at treating liver disease. Diuretics are usually administered, which help remove the fluid. Limiting salt in the diet [less than 1500 mg/day of sodium], avoiding drinking alcohol will also help in managing cirrhotic ascites. Surgical procedures include ascitic tapping. In cases where there is frequent requirement of ascitic tapping, a procedure called transjugular intrahepatic portosystemic shunt [TIPS] is carried out. Liver transplant is the last resort for the patients with cirrhotic ascites.
Other Modes of treatment
The other modes of treatment can also be effective in treating cirrhotic ascites. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating cirrhotic ascites.
