Ascites - A Complication of De-Compensated Liver Cirrhosis

Ascites (fluid retention in the stomach) is a common complication of the de-compensated cirrhotic stage of diseases. The main underlying causes are portal vein hypertension, low serum albumin level, and lymph over-formation in the liver and spleen. This in turn, causes leaks on the surface of the liver and the membrane of the stomach-cavity.

The long-term prognosis of ascites is dependent on three factors: the degree of reversibility, the control of the underlying liver disease, and the patient’s response to treatments. If the underlying liver disease can be controlled by effective treatment, then the ascites can be reversed quickly and the fluid can be released. With time, the patient can eventually restore their liver functions to the compensated level.  However, if the patient develops other complications, such as the deterioration of kidney functions and spontaneous bacterial infections in the stomach cavity (peritonitis), the prognosis will worsen. Therefore, ascites is a serious condition that requires immediate care and active treatment as soon as it is found.

To treat ascites, first important step is the restriction of salt intake. Generally, salt intake should not exceed 2 grams per day for a patient with ascites, and in persistent and severe cases, salt should be completely eliminated from the diet. Because most prepared foods from supermarkets contain salt or sodium, it is important to read the label carefully.  

In conventional western medicine, a diuretic medication is usually used. Sometimes, the rate of the fluid release can become too high and cause a decrease in blood volume. This can adversely affect cardiovascular functions and to avoid this, the diuretic dose should be calculated carefully while the patient is monitored closely. Fluid restriction is generally not necessary unless the serum sodium level becomes too low. Other treatment options for ascites include active draining of the fluid and evaluation for a liver transplant. Once the decision is made, the evaluation for liver transplantation should be done as early as possible because the availability of the liver donors is very limited and the waiting period can be quite lengthy.