Ascites

Ascites is a condition that occurs when fluid builds up in the abdomen, causing swelling and discomfort. It often signals a serious underlying issue, typically related to liver disease. As a nurse, you will come across patients facing all kinds of health issues and conditions. You are the healthcare professional that interacts the most with patients and provides essential treatments.  

However, helping your patients recover to full health and improving overall outcomes requires patients to fully understand their medical conditions.  Understanding conditions like ascites can help you prepare patients and their families to deal with this health problem better.

In this Fast CE For Less guide, we will cover essential information about ascites, including its causes, symptoms, and treatments.

What is Ascites?

Ascites is the name given to the buildup of abdominal fluid in the space between a person’s organs and their abdominal lining. The medical term for this space is peritoneal cavity. The fluid buildup inside this cavity can become very uncomfortable and painful for a person and cause clearly visible swelling of the belly.

Ascites happens primarily when the fluid balance in the body is imbalanced from conditions that affect the liver, like severe scarring or cirrhosis. The liver is the organ essential to keeping the fluid levels in our bodies well-maintained. If the liver suffers damage, fluid can buildup, and leak into the peritoneal cavity.

In addition to being uncomfortable and unsightly, ascites can lead to significant problems for a patient. As a nurse, it is essential to know how to identify and address it as quickly as possible.

Complications of Liver Disease

Cirrhosis, or liver damage, is considered to be the primary reason ascites occurs in patients. It is responsible for 80% of the cases of ascites, but dialysis, tuberculosis, pancreatic diseases, and heart failure can also lead to fluid buildup in the abdomen.

Cirrhosis is a condition where the liver becomes severely scarred and damaged. When the liver is damaged, it cannot function properly, leading to increased pressure in the blood vessels around it, known as portal hypertension. This pressure causes fluid to leak from the vessels into the abdominal cavity, resulting in ascites. As the most significant cause of the condition, nurses must understand the link between cirrhosis and ascites. Managing liver health can help prevent or reduce the severity of the condition and prevent further complications for your patients.

Portal Hypertension

Portal hypertension occurs when there is an increase in blood pressure within the portal vein system, which carries blood from the digestive organs to the liver. The increased pressure is often a direct result of cirrhosis. As the liver becomes more scarred, blood flow is obstructed, leading to higher pressure in the portal vein. This pressure forces fluid out of the blood vessels and into the abdomen, causing ascites. Nurses need to be aware of the signs of portal hypertension and its role in ascites to provide effective patient care.

Other Liver Conditions

Apart from cirrhosis, other liver conditions can also lead to ascites. These include hepatitis, fatty liver disease, and liver cancer. Each of these conditions affects the liver’s ability to function and regulate fluid balance. For instance, hepatitis can cause liver inflammation and damage, while fatty liver disease can lead to liver enlargement and dysfunction. Recognizing these conditions early and understanding their potential to cause ascites can help nurses in planning and providing comprehensive care to their patients.

Causes of Ascites

Ascites can be the result of several possible underlying conditions, effectively making it a symptom of major underlying problems affecting a patient. To prevent ascites from getting worse and endangering a patient’s life, it is important to diagnose and address the underlying condition. The primary causes include liver disease, heart failure, kidney failure, and cancer.

Cirrhosis

Cirrhosis is the most common cause of ascites. It occurs when the liver is severely scarred and damaged, leading to decreased liver function and fluid accumulation in the abdomen.

Heart Failure

Heart failure can lead to ascites by causing increased pressure in the blood vessels of the liver. This pressure can force fluid into the abdominal cavity.

Kidney Failure

Kidney failure affects the body’s ability to remove excess fluid, which can then accumulate in the abdomen, leading to ascites.

Cancer

Certain cancers, particularly those affecting the abdominal organs, can cause ascites. Tumors can block lymphatic drainage, leading to fluid buildup.

What are the Symptoms of Ascites?

Ascites presents with several symptoms that can affect a patient’s quality of life. Recognizing these symptoms early can help in timely intervention and management.

Abdominal Swelling

The most noticeable symptom of ascites is abdominal swelling. As fluid accumulates, the abdomen becomes distended, which can be uncomfortable and visually apparent.

Rapid Weight Gain

Patients with ascites may experience rapid weight gain due to fluid retention. This weight gain is not related to fat or muscle increase but solely due to the excess fluid in the abdomen.

Bloating and Discomfort

Bloating and discomfort are common symptoms. The buildup of fluid puts pressure on the stomach and intestines, causing a feeling of fullness and unease.

Shortness of Breath

As fluid accumulates, it can push against the diaphragm, leading to difficulty breathing. This symptom can be particularly distressing for patients.

Difficulty Eating

The pressure from the fluid can also cause a feeling of fullness or early satiety, making it hard for patients to eat normal amounts of food.

Complications from Untreated Ascites

If left untreated, ascites can lead to serious complications such as spontaneous bacterial peritonitis (an infection of the fluid), hepatorenal syndrome (kidney failure), and severe respiratory issues due to increased pressure on the lungs.

Treatment for Ascites

Treating ascites involves addressing the underlying cause and managing the symptoms. There are several medical treatments and lifestyle modifications that can help.

Medical Treatments

• Diuretics: Medications that help the body eliminate excess fluid through urine. Common diuretics used include spironolactone and furosemide.
• Paracentesis: A procedure where a needle is inserted into the peritoneal cavity to drain out the extra fluid. This provides relief from discomfort and pressure.
• TIPS (Transjugular Intrahepatic Portosystemic Shunt): A procedure that creates a pathway within the liver to reduce pressure in the veins and decrease fluid buildup.
• Liver Transplant: In severe cases of liver disease, a liver transplant may be necessary. This can cure the underlying cause of ascites.

Lifestyle Modifications

• Low-Sodium Diet: Reducing sodium intake can help prevent fluid retention. Patients are often advised to avoid salty foods and to use salt substitutes.
• Limit Alcohol Intake: Alcohol can worsen liver damage. Patients with ascites are usually advised to avoid alcohol completely.
• Regular Monitoring: Regular check-ups with healthcare providers to monitor fluid levels and liver function are essential in managing ascites effectively.

By combining medical treatments with lifestyle modifications, patients can manage ascites more effectively. As a nurse, you play a key role in educating patients about these treatments and supporting them in their road to recovery.

If you have not completed your nursing continuing education requirements to renew your license and want to learn more, online nursing CEUs offered by Fast CE For Less can help.

To access flexible and affordable nursing continuing education courses and state bundles, visit www.fastceforless.com.