OVERVIEW

What is cirrhotic ascites?

Cirrhotic ascites, commonly referred to as hepatic ascites, is essentially the accumulation of fluid in the abdominal cavity due to cirrhosis. It is a symptom caused by cirrhosis, which can result from one or multiple factors such as hepatitis B or chronic alcohol abuse, leading to portal hypertension and liver dysfunction, thereby triggering fluid buildup^[1].

Is cirrhotic ascites common?

Cirrhotic ascites is relatively common among patients with cirrhosis. It is one of the most frequent complications caused by cirrhosis, indicating that the disease has progressed to a more severe stage.

What are the common symptoms of cirrhotic ascites?

The primary symptom is abdominal distension. Additionally, many patients may experience edema in the feet, fatigue, and loss of appetite.

As ascites increases and restricts chest movement, some patients may also develop difficulty breathing.

The presence of a large amount of fluid may cause abnormal sounds in the abdomen, such as a sloshing noise when moving.

What are the signs of mild cirrhotic ascites?

In the early stages, mild cirrhotic ascites often presents with subtle symptoms, such as slight abdominal bloating or an increase in waist circumference. Many patients only realize they have ascites when they notice a sudden increase in abdominal size.

Therefore, cirrhosis patients should monitor changes in waist circumference and be aware of any bloating sensations.

What are the signs of severe cirrhotic ascites?

In addition to early symptoms like bloating, as ascites worsens, some patients may experience difficulty breathing, leg swelling, and reduced urine output.

These symptoms indicate significant fluid accumulation, which may already be causing damage to the kidneys and digestive organs.

What underlying diseases may contribute to cirrhotic ascites?

Many conditions can damage the liver, leading to cirrhosis and subsequently ascites. The most common causes include:

1. Chronic viral hepatitis, such as hepatitis B or C.
2. Chronic heavy alcohol consumption: Drinking for more than 5 years, with daily intake ≥40g for men and ≥20g for women^[1].
3. Non-alcoholic steatohepatitis, such as autoimmune hepatitis.
4. Other causes: Obesity, metabolic syndrome, insulin resistance, cholestasis, long-term use of hepatotoxic drugs or exposure to toxins, hepatic vein obstruction, schistosomiasis, liver fluke infection, etc.^[2].

Who is at higher risk of developing cirrhotic ascites?

Individuals with the following risk factors are more susceptible:

1. Chronic heavy drinkers (as defined above).
2. Those taking or exposed to liver-damaging drugs or toxins.
3. Patients with chronic viral hepatitis (e.g., hepatitis B or C).
4. Individuals with untreated chronic cholestasis.
5. Patients with parasitic infections like schistosomiasis or liver flukes.
6. Those with autoimmune hepatitis.
7. Individuals with a family history of liver disease or metabolic disorders.

Which department should I visit for cirrhotic ascites?

Patients can consult the gastroenterology or hepatobiliary surgery department.

What should I prepare before a medical visit for cirrhotic ascites?

Doctors will first review the patient's medical history to assess the presence and severity of ascites. Patients should prepare the following information:

1. What symptoms are present?
2. When did they start?
3. Have they worsened or occur intermittently?
4. Are there signs like fatigue, loss of appetite, or jaundice?
5. History of viral hepatitis (e.g., hepatitis B or C) and treatment details.
6. Alcohol consumption habits (duration and daily amount).
7. Any episodes of vomiting blood, black stools, confusion, or delirium?
8. Other discomforts beyond digestive symptoms.

What tests are needed for cirrhotic ascites?

If cirrhotic ascites is suspected, doctors may recommend:

• Physical examination: Checking for abdominal swelling or leg edema.
• Abdominal ultrasound: Detecting fluid accumulation.
• Abdominal CT: Confirming fluid presence and identifying masses.
• MRI: Also detects fluid but is time-consuming and costly.
• Paracentesis: Analyzing ascitic fluid to determine its cause.

Is paracentesis painful? Is it necessary?

Paracentesis helps diagnose the cause of ascites or detect infections (e.g., spontaneous bacterial peritonitis). If recommended by a doctor, it should be performed despite discomfort.

Can cirrhotic ascites resolve on its own?

Without proper treatment, it typically does not improve spontaneously.

How is cirrhotic ascites treated?

Treatment depends on severity and may include:

1. Fluid and sodium restriction: Daily water intake <1L, salt <2g (or <500mL for hyponatremia).
2. Diuretics (e.g., furosemide, spironolactone).
3. Treating underlying causes (e.g., antiviral therapy) and infections (e.g., antibiotics).

For severe cases, therapeutic paracentesis or surgery may be considered.

Note: Treatment must be guided by a doctor.

What happens if cirrhotic ascites is left untreated?

Untreated ascites may lead to upper gastrointestinal bleeding, black stools, or bloody vomit. Severe cases can cause respiratory distress.

Is a liver transplant necessary for cirrhotic ascites?

If medications fail and refractory ascites or liver failure occurs, transplantation may be recommended to improve quality of life.

Dietary precautions for cirrhotic ascites patients?

Easily digestible foods and adequate plant-based protein (e.g., beans) are recommended. Protein intake should be limited if hepatic encephalopathy is a risk.

Lifestyle considerations for cirrhotic ascites patients?

1. Monitor symptoms (e.g., jaundice, edema, bleeding).
2. Regular liver function tests (every 1–2 months).
3. Follow dietary guidelines.
4. Avoid alcohol; seek counseling if needed.
5. Avoid hepatotoxic drugs; use supplements cautiously.
6. Rest adequately, especially during complications like bleeding.

Can cirrhotic ascites be prevented? How?

1. Strictly avoid alcohol.
2. Avoid liver-damaging drugs or toxins.
3. Prevent viral hepatitis through vaccination and safe practices.
4. Avoid contaminated water to prevent parasitic infections.
5. Maintain a healthy weight with a balanced diet (low-fat, high-fiber).