Ascites (Excess Abdominal Fluid); Causes, Symptoms and Treatment

Diagnosing Ascites

Despite all the symptoms mentioned above, ascites remains a diagnosis of the cause rather than the manifestation. Unless the cause is known and treated, ascites is unlikely to go away. Your doctor will listen to your complaint and will ask you some questions to establish the cause. The onset of the disease and how long has it been present are very important. Afterwards they will perform a physical examination of your abdomen.

After establishing the severity of your condition, you may be hospitalized if needed, but if your condition is mild, you may be followed up using a group of investigations. Investigations can be laboratory or imaging finds. The most commonly performed laboratory tests include:

  • A complete blood count is needed to assess your general condition. It can also give clues if you are suffering from anemia, infection, or other blood-related problems.
  • Liver function tests: Liver function tests assess both liver damage and its ability to perform its functions. They are needed in all cases of ascites both to know the cause and to assess the level of liver damage. They include liver enzymes, which rise in case of liver inflammation, and albumin level, which decreases when the liver is impaired.
  • Kidney function tests: Kidney function tests are needed to assess if it is the cause of this ascites or if it is affected by it. Ascites can cause hepatorenal syndrome if it is caused by liver disease.
  • Electrolyte levels in blood: Electrolytes including sodium and potassium can be affected by ascites and should be assessed. Even minor deviations from normal can affect the heart and other organs.

Additional Lab Studies

Many other lab studies may be indicated according to your case including those related to other organs such as tumor markers if ovarian tumors are suspected. In addition, some imaging studies may be needed including:

  • Abdominal ultrasound: Abdominal ultrasound is used for many reasons in ascites. It assesses the condition of the liver and the presence of ascites, it also helps in drainage of the fluid collection, a procedure known as paracentesis. It is needed in assessing other organs including the kidney and the blood vessels.
  • CT scan and MRI: Both of those imaging modalities can be used for specific diagnoses including ovarian, kidney and blood vessels conditions.

In addition to the above, the most important procedure done to diagnose the type of ascitic fluid is ascitic tap. Ascitic tap means that small amounts of the fluid accumulated in the abdomen are examined under the microscope and assessed biochemically. It can differentiate between the ascites resulting from liver disease, for example, and that resulting from lymphatic obstruction. It is also essential in diagnosing infection of ascitic fluid, a condition known as spontaneous bacterial peritonitis.

Written by Martin Davis