Ascites – a symptom of severe liver disease

The portal vein (vena portae) collects the venous blood from the abdominal organs. This includes the gastrointestinal tract: the stomach, small intestine and large intestine (except for the lower two-thirds of the rectum). Venous blood from the pancreas and spleen also drains into the portal vein.

The nutrients, toxins or drugs absorbed by the intestines first reach the liver, where liver cells transform and neutralize them. This detoxifying function is extremely important for your whole body, because the liver protects it from the damaging effects of toxic substances.

From this it should be obvious that the toxins absorbed from the digestive tract reach the liver in the highest concentration.

Accumulation of abdominal fluid. What causes it?

So the venous blood from “half your body” must pass through the liver like a “filter”. If it becomes “clogged”, it obstructs the passage of blood through it.

Imagine opening a tap and then kinking a garden hose. Only a little water trickles through, while the hose becomes increasingly tense and may burst.

Similarly, pressure increases in the veins leading to the liver and fluid slowly “seeps” through the vessel wall into the abdominal cavity – ascites develops. Ascites already indicates an advanced condition, usually the end stage of liver disease. The appearance of ascites is an unfavorable sign.

At the same time as ascites, swelling (edema) may also appear on the lower limbs, which is usually due to general problems of venous circulation and/or heart function and is not directly caused by the ascites.

Which liver diseases can cause ascites?

Any condition that damages liver tissue. I will mention only a few common ones.

• Mostly (more than 60%) it is a consequence of cirrhosis caused by alcohol. Alcohol is a toxin, and the liver does the bulk of its neutralization. In this process the liver tissue is damaged, transformed and gradually destroyed. The liver first enlarges, then begins to shrink as connective tissue accumulates. Eventually it becomes almost rock-hard and blood cannot flow through it.
• Hepatitis – inflammatory disease of the liver tissue that causes scarring in the liver
• Malignant tumors and their metastases
• Effects of severe heart disease.

How can ascites be reduced?

In ascites the underlying disease must be treated primarily. If drug therapies are already ineffective, the only method is "paracentesis". Through a needle inserted through the abdominal wall into the abdominal cavity the abdominal fluid simply "flows out". Compression therapy (lymphatic massage) cannot reduce ascites; in fact… pressing on the abdomen from the outside can increase the symptoms.

Paracentesis is symptomatic treatment, meaning it does not improve the underlying condition. The swelling reaccumulates (initially slowly, then at an increasingly rapid rate). Repeated paracenteses represent a huge drain on the patient’s energy and accelerate weakening and deterioration. If abdominal tension is severe, paracentesis may be the only way to relieve suffering — even when the patient’s overall condition and prognosis are known to be unfavorable.