The relationship between cirrhosis and ascites is primarily causal; cirrhosis, which is a liver problem, is the primary cause of ascites, a condition that causes the abdominal cavity to fill with fluid and become painfully distended. There are a number of reasons why people might develop ascites, but experts typically say that roughly 65% of cases are related directly to advancing cirrhosis. In fact, it’s often the case that cirrhosis isn’t even detected or diagnosed until a patient presents with a painful swollen stomach. Both conditions can be very serious, and there tend to be more complications when the two occur together. In general it’s usually a lot easier to cure ascites than cirrhosis, but a lot depends on how advanced the problems are and how responsive patients are to treatment.
Understanding Cirrhosis Generally
Cirrhosis is a condition in which the tissues of the liver, one of the body’s most important organs, becomes so scarred that it cannot perform its filtration role properly or at all. In healthy people, the liver processes blood, creates bile for digestion, and filters toxins out of the body. Alcohol and most medications are usually considered “toxins,” and in moderate or occasional amounts these don’t pose problems. Repeated exposure, as often experienced by alcoholics and drug addicts, can lead to scars on the surface of the liver as the organ struggles to keep up. Over time, these scars become more engrained and more numerous until the majority of the organ is scar tissue rather than functioning, healthy tissue.
Once cirrhosis sets in, the liver usually begins to fail. It’s this failure that commonly leads to the fluid build-up known as ascites.
Any fluid in the abdominal cavity is typically known as “ascites,” and the name is more indicative of a state of being than any defined condition or disease. Accumulation of abdominal fluid almost always has a cause, which is to say, it is abnormal and won’t happen all on its own. It may be caused by several diseases, including heart failure, viral infection, and various cancers, but cirrhosis is the most common.
In these cases, fluid usually accumulates as liver function deteriorates and pressure in the veins that pass through that organ increases. The result is that fluid seeps or leaks from the surface of the liver into the abdominal cavity, where it collects. Edema, the accumulation of fluid in the feet or legs, may also accompany cirrhosis and ascites.
Small amounts fluid aren’t usually noticed by the patient. Larger volumes frequently cause the patient to feel bloated or full in the abdomen, though, which is usually paired with pain and sleeplessness, among other symptoms. The presence of ascites is usually confirmed through diagnostic imaging tests such as ultrasound or computed tomography (CT) scan.
Complications When the Two Occur Together
While both conditions can be quite serious, experiencing the two together usually compounds a patient’s problems. Increasing intra-abdominal pressure from ascitic accumulation may result in abdominal pain or discomfort, decrease in appetite, and infection, all of which can put pressure on the already inflamed liver and can, in turn, cause the organ to deteriorate faster. Large-volume ascites accumulation may also result in a hepatic hydrothorax in which ascites enters the chest and accumulates between the chest and the lung in the pleural space. The resulting condition, known as a pleural effusion, may result in the patient experiencing difficulty breathing or shortness of breath.
Care and Treatment Options
Short-term treatment of hepatic ascites in the case of large-volume ascites may involve paracentesis. Paracentesis is a procedure that involves inserting a needle into the abdomen to draw off the accumulated abdominal fluid. While this may provide immediate relief from some of the discomfort and complications associated with the abdominal fluid accumulation, it won’t usually prevent it from recurring, particularly not if the cause, like cirrhosis, is still in full force. Long-term treatment of cirrhosis and ascites may include a special diet, the use of diuretic medications to help reduce ascites and edema and, in the most extreme cases, liver transplant.