Most people do not pay any attention to their suddenly expanding waistlines unless their doctor advises them to cut down on goodies and junk food. However, the fact is that there could be another, more serious reason behind rapidly gaining weight. This is where you should turn your attention to ascites, which is a condition caused by severe liver disease. If your doctor believes you have ascites, then your doctor will perform a procedure known as paracentesis to remove the fluid from your abdomen.
Here’s everything you need to know about ascites and paracentesis.
What is Ascites?
Ascites is a condition in which there is a buildup of fluid inside the abdomen. The accumulated fluid has to be more than 25 milliliters (mL).(1) Ascites is a condition that typically happens when the liver stops functioning properly. When the liver malfunctions, fluid starts to fill up the space between the organs and the abdominal lining.
According to the 2010 clinical guidelines that were published in the Journal of Hepatology, (2) the two-year survival rate of ascites is 50 percent.
This fluid can cause bloating, pain, and breathing difficulties.
What are the Causes of Ascites?
The most common cause of ascites is liver scarring or cirrhosis. Scarring of the liver increases the pressure inside the blood vessels of the liver. This increased pressure forces the fluid into the abdominal cavity, which results in ascites.
Ascites can be caused by a variety of other conditions, including:
Risk Factors for Ascites
Liver damage is one of the biggest risk factors for ascites. Some of the causes of liver damage may include:
Some other conditions also increase your risk of ascites. These include:
- Kidney or heart failure
- Ovarian, liver, pancreatic, or endometrial cancer
What is Paracentesis?
Paracentesis, more commonly known as an abdominal tap, is a procedure that is used for treating ascites. Paracentesis removes the excess fluid present in the abdominal cavity. As mentioned above, under normal circumstances, there should be no ascites (excess fluid) within the abdomen.
What Happens During Paracentesis?
Paracentesis can either be performed in a doctor’s office or the hospital. Keep in mind that you cannot drink or eat anything at least 12 hours before the procedure. You also need to have an empty bladder.(3)
Paracentesis takes around 15 to 20 minutes, and there is no need for general anesthesia. Paracentesis is done in the following steps:
- The area is cleaned and shaved.
- The doctor applies a local anesthetic and numbs the area. If there is a larger amount of fluid to be removed, then your doctor may need to make a small incision in the skin to accommodate the needle.
- Once the area is prepped, the doctor then inserts the needle tap into the skin. This needle itself will only go inside up to 1 or 2 inches deep. The fluid is extracted with the syringe.
- Your doctor then removes the needle. There may or may not be a requirement to use ultrasound during paracentesis.
The amount of fluid removed depends on the original purpose of the procedure. If your doctor performs a small diagnostic tap, or they may perform a large volume tap to remove a large amount of fluid. During a large volume tap, your doctor will go ahead and remove several liters of fluid to reduce the pressure and pain. In this case, a tube may also be attached to the needle and syringe to help the doctor take out more fluid.
After the procedure of paracentesis is completed, your doctor will dress the wound and, if needed, put in the stitches as well.
Ascites is not a condition that can be prevented. However, you can lower your risk of ascites by taking care of your liver. This will also prevent the need for having to undergo paracentesis. Ascites is not a normal condition, and when there is fluid buildup, a paracentesis becomes necessary to remove the fluids and also for determining the cause of this fluid buildup. Recovering from paracentesis is pretty straightforward, and you will be able to resume your daily activities once the wound heals.
- SAGE Journals. (2019). Management of cirrhotic ascites – Julie Steen Pedersen, Flemming Bendtsen, Søren Møller, 2015. [online] Available at: https://journals.sagepub.com/doi/10.1177/2040622315580069 [Accessed 21 Oct. 2019].
- European Association For The Study Of The Liver, 2010. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Journal of Hepatology, 53(3), pp.397-417.
- Runyon, B.A., 1986. Paracentesis of ascitic fluid: a safe procedure. Archives of internal medicine, 146(11), pp.2259-2261.