Ascites causes, symptoms, classification and other risk factors


There are many people who do not think too much about that expanding waistline – other than knowing they should lose a few pounds. Doctors often recommend to eat fewer goodies and to cut down on alcohol. But you should know that there could be more to it. Your doctor can tell you about ascites. Ascites is a condition when there is a fluid buildup inside the abdomen. They are usually happening when the liver stops working properly. This fluid fills the space between the organs and the lining of the abdomen. There are some studies in which are said that people who have cirrhotic ascites are having a 2 – year survival rate of approximately 50% [1]. This is a reason why you should talk with your doctor as soon as possible if you are experiencing some symptoms of ascites. Malignant ascites is a term which is used to describe those ascites that are caused by cancer. This type of ascites is most common in people who have some of the below mentioned types of cancers:

  • Uterine cancer
  • Pancreatic cancer
  • Ovarian cancer
  • Gastrointestinal tract cancers, such as stomach and intestinal cancers
  • Colon cancer
  • Breast cancer

Ascites symptoms

The symptoms of this condition can appear in both ways – slowly or suddenly which depends on the cause of the fluid buildup. These symptoms do not always signal an emergency situation, but if you have noticed some of the below mentioned symptoms, then you should talk with your doctor as soon as possible. Here are some symptoms of ascites:

  • Heartburn
  • Indigestion
  • Nausea and vomiting
  • Sense of fullness or bloating
  • Shortness of breath, also called dyspnea
  • Abdominal pain
  • Diminished appetite
  • Hemorrhoids, which causes painful swelling near the anus
  • Abdominal swelling
  • Difficulty breathing when lying down
  • A distended (swollen) abdomen
  • Sudden weight gain
  • Ankle swelling
  • Changes to the belly button
  • Sense of heaviness

If you have some of the above mentioned symptoms, then you should speak with your doctor. They are often a sign of liver failure and it happens most often with cirrhosis [2]. You should keep in your mind that the mentioned symptoms of ascites can be also caused by other conditions. It is very important to talk with your doctor as soon as possible because the early treatment is always the best. He or she will give you a physical exam and will ask you about your symptoms. Also your doctor can make a variety of tests such as a CT scan, an ultrasound and blood work. If your doctor thinks that you have ascites, then he or she will use a needle to remove the fluid from your abdomen for testing. This type of procedure is known as paracentesis. With this procedure, your doctor will find the cause for your condition so he or she will give you a proper treatment. In the most cases, people who are affected with ascites are referred to a liver specialist because this type of doctor can discuss with you about a liver transplant.

Symptoms of ascites

Ascites causes

In the most cases ascites are caused by the liver scarring. This is increasing the pressure which is inside the blood vessels of the liver. This increased pressure can force the fluid into the abdominal cavity which is causing ascites. The liver damage is the biggest risk factor for ascites. Here are some factors which can cause liver damage:

  • A history of alcohol use [3]
  • Hepatitis B or C [4]
  • Cirrhosis [2]

Risk factors: Also there are other conditions which can increase your risk of ascites such as

  • Hypothyroidism [5]
  • Tuberculosis [6]
  • Pancreatitis [7]
  • Heart or kidney failure [8]
  • Ovarian, pancreatic, liver or endometrial cancer [9]

Classification: There are some studies in which are shown that ascites exist in 3 grades and they are:

  • Grade 1: When someone has this type of ascites, then he or she has ascites which are mild and only visible on ultrasound and CT.
  • Grade 2: When someone is affected with this grade of ascites, then he or she has ascites which are detectable with flank bulging and sifting dullness.
  • Grade 3: When someone has this grade of ascites, then he or she has directly visible ascites which are confirmed with fluid wave/thrill test.


[1] Runyon BA. Management of adult patients with ascites due to cirrhosis. Hepatology. 2004;39(3):841-56.

[2] Pedersen JS, Bendtsen F, Moller S. Management of cirrhotic ascites. Therapeutic Advances in Chronic Disease. 2015;6(3):124–37.

[3] Simpson RF, Hermon C, Liu B, et al. Alcohol drinking patterns and liver cirrhosis risk: analysis of the prospective UK Million Women Study. The Lancet Public Health. 2019;4(1):E41-E48.

[4] Seo JH, Kim SU, Park JY, et al. Predictors of refractory ascites development in patients with hepatitis B virus-related cirrhosis hospitalized to control ascitic decompensation. Yonsei Medical Journal. 2013;54(1):145–53.

[5] Khalid S, Asad-Ur-Rahman FNU, Abbass A, et al. Myxedema ascites: A rare presentation of uncontrolled hypothyroidism. Cureus. 2016;8(12):e912.

[6] Kashyap RS, Saha SM, Nagdev KJ, et al. Diagnostic markers for tuberculosis ascites: A preliminary study. Biomarker Insights. 2010;5:87–94.

[7] Karlapudi S, Hinohara T, Clements J, Bakis G. Therapeutic challenges of pancreatic ascites and the role of endoscopic pancreatic stenting. BMJ Case Reports. 2014;2014:bcr2014204774.

[8] Aisenberg GM. Peritoneal catheter for massive cardiac ascites. BMJ Case Reports. 2013;2013:bcr2013008992.

[9] Li X, Zhu D, Li N, et al. Characterization of ascites‐derived tumor cells from an endometrial cancer patient. Cancer Science. 2017;108(12):2352–7.


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