Ascites

Ascites is the buildup of fluid in your belly, often due to severe liver disease. The extra fluid makes your belly swell. A sheet of tissue called the peritoneum covers the abdominal organs, including the stomach, bowels, liver and kidneys. The peritoneum has two layers. Ascites happens when fluid builds up between the two layers.

How common is ascites?

Fluid buildup rarely occurs in otherwise healthy people. It develops as a result of other diseases, most often cirrhosis. Ascites is the most common complication of cirrhosis. About half of people with decompensated cirrhosis will develop ascites. Cirrhosis accounts for about 80% of the cases of ascites.

How does cirrhosis cause ascites?

When you have cirrhosis, your liver doesn’t function as it should. The decrease in liver function combines with portal hypertension to cause ascites symptoms. Portal hypertension is high pressure in the portal vein that delivers blood to your liver. The high pressure causes fluid to leak out of your veins into your belly and collect there.

The Signs and Symptoms —

Ascites is usually accompanied by a feeling of fullness, a ballooning belly and fast weight gain.

Other symptoms often include:

• Shortness of breath
• Nausea
• Swelling in legs and ankles
• Indigestion
• Vomiting
• Heartburn
• Loss of Appetite
• Fever
• Hernia

The Causes —

Ascites happens when pressure builds up in the veins of liver and it doesn’t work as it should. These two problems usually are caused by another condition —

• cirrhosis
• heart or kidney failure
• cancer or
• an infection.

The pressure blocks blood flow in the liver. Over time this keeps your kidney from removing excess salt from your body. This is turn, causes fluid to build up.

Ascites Risk Factors —

Any disease that causes liver damage or scarring can make you more likely to get ascites. Common risk factors for ascites include: 

• Viral infections like hepatitis B or hepatitis C
• Alcohol misuse
• Cancer in organs in the belly area
• Kidney failure
• Congestive heart failure

Ascites Diagnosis —

The doctor will give you a physical exam and ask about your symptoms. They may perform a variety of tests, including blood work, an ultrasound, or a CT Scan.

If they think you have ascites, the doctor will use a needle to remove fluid from your belly for testing. This procedure is called a Paracentesis.

What is paracentesis —

Paracentesis is also called abdominal tap, is a medical procedure in which a needle or catheter is inserted into the peritoneal cavity (the area between the belly wall and the spine) to obtain ascitic fluid for diagnostic or therapeutic purposes .

Ascitic fluid may be used to help determine the cause of ascites, as well as to evaluate for infection or presence of cancer. Ascites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs.

Paracentesis can help diagnose the cause of fluid buildup (ascites) or the presence of an infection. Paracentesis may also be done to remove a large amount of fluid to reduce belly pain.

There are 2 kinds of paracentesis —

1. Diagnostic paracentesis — A small amount of fluid is taken and sent to the laboratory for testing.
2. Large volume paracentesis — Several liters may be removed to relieve abdominal pain and fluid buildup.

The Treatment —

The doctor may prescribe diuretics, to help flush the extra fluid from your body.

Limiting sodium in your diet is crucial for treating ascites. For people with ascites, recommended sodium intake is less than 2,000 to 4,000 milligrams a day.

A dietitian can help create a healthy eating plan for you. You may also need to take diuretics (water pills). These water pills help fluid and sodium leave your body.

Two of the most common diuretics are:

• Furosemide (Lasix)
• Spironolactone (Aldactone)

They both help your kidneys remove more sodium and water.

If changes in your diet and prescription diuretics don’t help, or your symptoms are severe, your doctor may have to use paracentesis to remove large amounts of excess fluid through a needle inserted into your belly. When you have this done, you have to follow a low-salt, low-liquid diet, otherwise the fluid will come back.

Ayurveda Treatment principle of Ascites (Udara) —

• Kaphahara, Agni dipana, Sneha varjita , Ruksha virechana and Mala shodhana
• Tikta Rasa, Shophaghna dravyas can be used.

Kashayam —

• Dashamula Punarnavadi Kashayam
• Pathyapunarnavadi Kashayam
• Sukumara Kashayam
• Dashamula Panchakoladi Kashayam
• Ardhavilvam Kashayam

Churnam —

• Narayana Churna
• Chardhula Churnam

Vati/ Gulika —

• Dugdha Vati
• Chandraprabha Vati
• Shiva Gulika
• Gomutra haritaki tablet

Virechana —

Virechana with Trivrut churnam

Other than Ruksha Virechana, all Panchakarma procedures are contra indicated.