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Ascites: The Symptoms

By Sharon Perkins ; Updated August 14, 2017

Ascites is an abnormal accumulation of fluid on the abdomen. Around 80 percent of people with ascites have cirrhosis of the liver, Glen Hastings, M.D., of the University of Kansas Wichita School of Medicine states. Heart failure, kidney disease, cancer and pancreatitis can also cause ascites. Ascitic fluid contains large amounts of albumin, a protein, and is usually a pale yellow color. Small amounts of fluid usually no cause no symptoms, but as amounts increase, so do symptoms. A doctor may not be able to detect fluid until a quart or more accumulates, the Merck Manual states.

Increased Abdominal Girth

The first symptom of ascites is often an increase in abdominal girth. When a person with ascites lies flat, the flanks, or sides of the abdomen, may bulge out. Pushing on one side of the abdomen can produce a fluid wave, which a doctor can feel by pressing down on the center on the abdomen with the side of his hand, according to the Family Practice Notebook. Fluid can be drained with a needle when accumulation causes severe discomfort; this procedure is called a paracentesis.

Gastrointestinal Symptoms

Appetite decrease, discomfort and a feeling of fullness after a small amount of fluid are common, due to crowding of the intestines. Heartburn and nausea may also occur. Crowding of the intestines may cause constipation, or difficulty passing stool.

Respiratory Symptoms

When large amounts of fluid accumulate, the lungs are crowded, making it hard to breathe. People with ascites may get out of breathe with minimal exertion or may have hard time taking a deep breath. In 5 to 10 percent of patients, fluid accumulates around the lungs, called a hepatic hydrothorax or pleural effusion. This is more common on the right side, the American College of Gastroenterology reports. Cough and low oxygen levels may occur with hepatic hydrothorax. Fluid around the lungs can be withdrawn if it's causing serious respiratory effects.

Inguinal or Umbilical Hernias

Hernias, openings in the abdominal wall, are common in patients with ascites because of the pressure exerted by the fluid on the abdomen. The navel may be pushed out due to an umbilical hernia. Hernia repair should be done only by surgeons experienced in treating cirrhosis patients, the American College of Gastroenterology states, and only if absolutely necessary.

Other Symptoms

People with ascites usually feel extremely tired. They become short of breath with any exertion and find it difficult to walk any distance. Lower back pain is common from the strain on back muscles. Fluid may travel down the legs and accumulate in the ankles or feet. Resting with feet elevated may help reduced lower extremity swelling.

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