Ascites

Description:
Ascites is a common complication of cirrhosis and is marked by an excessive accumulation of fluid in the abdominal cavity. Generally speaking, fluid retention — including ascites, peripheral edema and pleural effusion — is the most frequent complication of end-stage liver disease.

In approximately 15 percent of cases ascites is caused by certain types of malignancies in the gastrointestinal tract or in the ovaries, Hodgkin’s lymphoma,non-Hodgkin’s lymphoma, and metastatic carcinoma in the abdominal cavity. It is also linked less often with heart failure, tuberculosis, pancreatitis and even hypothyroidism.

The fluid in the abdominal cavity develops when protein leaks from the liver and the intestines. If it is just a small collection of protein-rich fluids, it may be difficult to detect. However, as more and more fluid leaks into the abdomen, dramatic swelling, discomfort, shortness of breath, loss of appetite and pressure on the lungs may occur.

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There are two main types of ascites and they are:
1. Uncomplicated Ascites:
In this type, the fluids are not infected. This type is broken into three levels:

Grade 1: Mild; an ultrasound is required to detect fluids

Grade 2: Moderate; symmetrical distention and swelling of the abdomen occurs

Grade 3: Severe; large or extreme distention of the abdomen occurs

2.Refractory Ascites:
When fluid buildup cannot be reduced by a low sodium diet or diuretics, it is considered refractory, meaning that more aggressive treatment may be required.

Ascites can occur in children where it is most commonly associated with liver, kidney and heart disorders. The symptoms are similar to those found in adults and treatment is similar.

Signs & Symptoms:
Common symptoms of ascites include:
*Shortness of breath
*A feeling of fullness
*Large belly develops quickly
*Swelling in the ankles and legs
*Indigestion
*Vomiting
*Heartburn
*Loss of appetite
*Nausea
*Hernia
*Abdominal distention with mild to moderate discomfort
*Painful abdominal distention
*Jaundice
*Muscle wasting
*Fever

Causes:

Causes of high serum-ascites albumin gradient (SAAG or transudate) are:

*Cirrhosis – 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%)
*Heart failure – 3%
*Hepatic venous occlusion: Budd–Chiari syndrome or veno-occlusive disease
*Constrictive pericarditis
*Kwashiorkor (childhood protein-energy malnutrition)
*Causes of low SAAG (“exudate”) are:
*Cancer (metastasis and primary peritoneal carcinomatosis) – 10%
*Infection: Tuberculosis – 2% or spontaneous bacterial peritonitis
*Pancreatitis – 1%
*Serositis
*Nephrotic syndrome
*Hereditary angioedema

Other rare causes:
*Meigs syndrome
*Vasculitis
*Hypothyroidism
*Renal dialysis
*Peritoneum mesothelioma
*Abdominal tuberculosis
*Mastocytosis

Risk Factors:
*Alcohol consumption
*Low protein diet
*History of jaundice
*History of chronic hepatitis B or hepatitis C
*Obesity
*Hypercholesterolaemia
*Type 2 diabetes
*Nonalcoholic fatty liver disease
*Cardiac disease
*Certain types of cancer
*Kidney disease

Diagnosis:
Routine complete blood count (CBC), basic metabolic profile, liver enzymes, and coagulation should be performed. Most experts recommend a diagnostic paracentesis be performed if the ascites is new or if the patient with ascites is being admitted to the hospital. The fluid is then reviewed for its gross appearance, protein level, albumin, and cell counts (red and white). Additional tests will be performed if indicated such as microbiological culture, Gram stain and cytopathology.

The serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites.[8] A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive as a cause.

Ultrasound investigation is often performed prior to attempts to remove fluid from the abdomen. This may reveal the size and shape of the abdominal organs, and Doppler studies may show the direction of flow in the portal vein, as well as detecting Budd-Chiari syndrome (thrombosis of the hepatic vein) and portal vein thrombosis. Additionally, the sonographer can make an estimation of the amount of ascitic fluid, and difficult-to-drain ascites may be drained under ultrasound guidance. An abdominal CT scan is a more accurate alternate to reveal abdominal organ structure and morphology.

Treatment:
Ascites is generally treated while an underlying cause is sought, in order to prevent complications, relieve symptoms, and prevent further progression. In patients with mild ascites, therapy is usually as an outpatient. The goal is weight loss of no more than 1.0 kg/day for patients with both ascites and peripheral edema and no more than 0.5 kg/day for patients with ascites alone. In those with severe ascites causing a tense abdomen, hospitalization is generally necessary for paracentesis.

Natural Ascites Treatments:
*Restrict salt intake and focus on following a diet designed for high blood pressure.
*Eat fresh vegetables and fruit, lean proteins, organic dairy products and sprouted whole grains.

*Eat small meals, more often. High-protein smoothies and nutrient-dense small snacks and meals derived from plant sources may help relieve some symptoms while keeping you satiated.

*Avoid toxins and chemicals by eating organic foods whenever possible.

*Drink coconut water if you are on a liquid-limiting diet. It doesn’t take as much coconut water to keep you properly hydrated.

*Drink dandelion root tea to increase urinary frequency and volume, which helps to reduce edema and fluid retention.

*Take Branched Chain Amino Acids and increase BCAA through diet by eating more grass-fed beef, wild-caught salmon, raw grass-fed cheese, ancient grains like quinoa and high-quality whey protein.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Ascites
https://draxe.com/ascites/

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