Distension of the abdomen is a common complaint encountered in clinical practice. Swelling is a sensation of fullness, and is common in patients with functional gastrointestinal disorders, normally occurs after meals and is of no significance.
Objective abdominal swelling refers to an increase in abdominal girth, which may be due to the presence of fluid in the peritoneum, which is known as ascites.
Understanding The Basics
Normal amount of fluid in the peritoneal cavity is 100 – 250 ml of lymph. Abnormal collection of fluid in the peritoneal cavity leads to swelling of abdomen. Significant amount of fluid produces fullness of flanks in a lying down position. Swelling can be associated with oedema if the cause of ascites is a systemic disorder. Localised disorders involving peritoneum produce isolated ascites with minimal or no oedema.
It occur due to transudation of fluid into the peritoneum in hypoproteinemic states. Causes of it can be local and systematic, which are as follows :
Local ( Ascites Without Oedema )
- Peritonitis ( Serous,exudate )
- Malignancy with secondaries in peritoneum
- Spontaneous bacterial peritonitis
Systemic ( Ascites With Oedema )
- Nephrotic syndrome
- Cirrhosis of the liver
- Hyperproteinemia ( Nutritional or following chronic diarrhoea or malabsorption )
- Malignancy liver
- Meig’s syndrome ( Ovarian syndrome )
It can take place from high pressure in certain veins of the liver and low blood levels of a protein called albumin. Diseases like chronic hepatitis, alcohol overuse, fatty liver disease etc, which are related to severe liver damage can lead to causes ascites.
Recognising Ascites ( Signs And Symptoms )
Mild abdominal enlargement may go undetected in certain patients while others may complain of increase in girth of abdomen, tightness of clothes, belts etc. When an increase in fluid takes place, It may cause abdominal pain and bloating. Large amounts of fluid can cause shortness of breath. Other symptoms include :
- Back pain
- Swelling in the ankles
- Digestive issues such as loss of appetite, constipation etc.
- Difficulty sitting
It can be detected with physical examination of the abdomen. Under inspection, tense distended abdomen can be seen in massive ascites. Prominent distended veins over abdomen indicate portal hypertension. Percussion note is dull in it. Other signs of ascites may be present due to its underlying cause.
Assessment And Imaging
Doctor performs a physical exam and asks about symptoms and medical history. Blood tests or imaging tests are required. After the initial exam, the doctor confirms the diagnosis and to find out its cause. Other Investigations include :
- Blood examination
- Urine examination
- Stool for occult blood
- Plain X – ray abdomen
- Diagnostic paracentesis
- Serum – ascites albumin gradient
The differential diagnosis of it depends on the cause of it and whether it is a part of generalised anasarca.
Ascites of nephrotic syndrome
Puffiness of face in the morning, pitting ankle oedema, slowly developing ascites. The massive albuminuria confirms the diagnosis.
Ascites due to cirrhosis of the liver
Past history of chronic liver disease, with history of recent episodes of haematemesis and jaundice in a patient of it suggest cirrhosis. Prominent abdominal veins seen due to cirrhosis.
Ascites due to hypoproteinemia
Anemia multiple deficiencies, muscle flabbiness atony of muscles with swelling of abdomen and oedema indicate hypoproteinemia to be its cause.
A slow developing swelling of the abdomen with anorexia, low grade fever, common in females than males.
Rapid filling tense ascites in old age decrease appetite, hemorrhagic nature of it could be due to malignancy anywhere in the abdomen with secondaries in the peritoneum.
It depends upon the underlying cause. If it is due to nephrotic syndrome, then it is managed as nephrotic syndrome. If it is due to bacterial peritonitis, then it is managed with antibiotics. If surgery is needed, treatment includes paracentesis, Transjugular intrahepatic portosystemic shunt (TIPS) and liver transplant. In case of cancer, chemotherapy or hormone therapy can help shrink the tumor.
Liver damage is the biggest risk factor for it. Some other conditions that increase risk for it are:
- Ovarian, pancreatic, liver, or endometrial cancer.
- Heart or kidney failure.
There are differential complications and risk factors take place due to it. By shedding light on the causes, symptoms, and treatment options, we empower individuals and healthcare professionals to navigate the path towards improved quality of life.