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Ascites

Contact the UPMC Center for Liver Diseases

To make an appointment with a hepatologist at the UPMC Center for Liver Diseases, call 412-647-1170 or fill out our contact form.


What Is Ascites?

Ascites is a buildup of fluid in the abdominal cavity.

People with ascites often have painful swelling of the belly. It can be a sign that your liver disease is getting worse.

Ascites causes

Cirrhosis of the liver is the main cause of ascites. More than 50% of people with cirrhosis develop ascites within 10 years of their liver disease diagnosis.

But sometimes people with congestive heart failure, hepatitis, or cancer get ascites.

Cirrhosis or other advanced liver disease causes scarring that makes it hard for the liver to filter the blood.

Since blood can't easily flow on its normal path into the liver, pressure builds up in the blood vessels nearby. This causes high blood pressure, known as portal hypertension, around the liver.

The fluid that the liver would normally filter builds up and moves into other parts of the body. This fluid often collects in the abdominal cavity.

There may be a small amount of fluid, or there may be enough to cause the belly to swell painfully.

Risk factors and complications of ascites

Liver damage is the biggest risk factor for ascites.

Problems that cause liver damage include:

Some other conditions that increase your risk for ascites are:

  • Ovarian, pancreatic, liver, or endometrial cancer.
  • Heart or kidney failure.
  • Pancreatitis.
  • Tuberculosis.
  • Hypothyroidism.

Having ascites makes it likely you'll have other complications of liver disease, such as:

  • Edema (swelling of legs and ankles).
  • Spontaneous bacterial peritonitis (unexplained and potentially life-threatening infection of the ascitic fluid).
  • Abdominal wall hernias.
  • Hepatorenal syndrome (kidney failure).
  • Hepatic encephalopathy (liver fails to properly remove toxins from the body, leading to mental confusion).
  • Hepatic hydrothorax (fluid that pushes into the lung cavity).

How to prevent ascites

The only sure way to prevent ascites is to keep your liver healthy.

If you have liver disease, you can prevent further damage by:

  • Eating a healthy diet.
  • Staying at a healthy weight.
  • Not drinking alcohol.
  • Seeing your liver doctor on a routine basis.

Why choose UPMC for ascites care?

Complications of liver disease can progress fast.

The doctors at the UPMC Center for Liver Diseases are experts at treating cirrhosis of the liver, ascites, and other complications.

UPMC has the latest in cutting-edge technologies and research in liver disease. And we're home to one of the oldest and most experienced liver transplant centers in the country.

Ascites Symptoms and Diagnosis

The signs of ascites can form slowly or come on fast. If there's only a small amount of fluid in the belly, you may not have any symptoms.

As the build-up of fluid increases, you may have symptoms such as:

  • Stomach pain.
  • Bloating.
  • Shortness of breath.
  • A swollen, hard abdomen (“pregnancy belly").
  • Belly button pushed out.
  • Sudden weight gain.
  • Decreased appetite.
  • Nausea and vomiting.
  • Heartburn.

Diagnosing ascites

Your doctor will do a physical exam and ask you about your health history, chiefly your liver disease.

They may order the following tests to confirm an ascites diagnosis:

  • Urine tests.
  • Kidney function tests.
  • Liver function tests.
  • Blood tests.
  • Abdominal ultrasound.
  • CT scan of the stomach.
  • Paracentesis to check for signs of infection or cancer.

Ascites Treatment

Ascites is a serious complication of liver disease. Your doctor will want to treat it as early as possible with these methods.

Lifestyle changes

Reducing your salt (sodium) intake is the first step in treating ascites.

Salt causes you to retain water, which can add to fluid buildup in the belly.

Medicine to treat ascites

Your doctor may prescribe diuretics or water pills.

Water pills can:

  • Rid your body of sodium and water.
  • Help lower portal hypertension.
  • Ease fluid buildup in the belly.

Procedures to treat ascites

Sometimes reducing salt in your diet and taking water pills aren't enough. You may need surgery or another type of treatment.

Types of procedures to treat ascites include:

  • Paracentesis to remove fluid from the abdominal cavity. A radiologist will use ultrasound to guide a needle into the stomach. They may need to repeat the procedure if fluid builds up again.
  • Transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal hypertension. Doctors place a stent into a vein to bypass the liver. The increased blood flow may relieve the buildup of fluids in the abdominal cavity.
  • Liver transplant. If other treatments don't work, you may need a liver transplant. Surgeons remove your diseased liver and replace it with a healthy one from an organ donor.