When Peritoneal Fluid Becomes Ascites in Hepatitis Patients

Peritoneal fluid is a normal, lubricating fluid found in the peritoneal cavity—the space between the layers of tissue that line the belly’s wall and the abdominal organs (such as the liver, spleen, gall bladder, and stomach).

idsection Of Overweight Man Against White Background

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The Purpose of Peritoneal Fluid

The primary function of peritoneal fluid is to reduce the friction between the abdominal organs as they move around during digestion. In a healthy person, there is normally a small amount of peritoneal fluid present in the peritoneal cavity. However, some problems in the body can cause excess fluid to accumulate in the cavity. This fluid is called ascitic fluid and leads to ascites, one of the complications of cirrhosis.

How Does Ascites Develop?

Ascites is most common in patients who have diseases affecting the liver. Damage to the liver can cause high blood pressure in the veins that deliver blood to the liver, a condition known as portal hypertension. However, many other disorders can cause ascites as well, including cancer, heart failure, kidney failure, inflammation of the pancreas (pancreatitis), and tuberculosis affecting the lining of the abdomen.


When the condition is mild, there may be no noticeable symptoms. However, when moderate amounts of fluid are present in the abdomen, a person may notice they waist size has increased and they may have gained weight. Larger amounts cause even more symptoms, including swelling of the abdomen and discomfort. In these patients, the abdomen may feel tight and stretched, as in a pregnancy, and the bellybutton may begin to protrude.

When ascites reaches an advanced level, swelling in the abdomen puts pressure on the stomach, which can lead to appetite loss, as well as the lungs, which can lead to shortness of breath. Some patients notice swelling in other areas of the body as well, such as the ankles.

A complication of ascites, bacterial peritonitis, is an infection that can cause abdominal discomfort and tenderness as well as fever and malaise. Confusion, disorientation, and drowsiness can develop and, if untreated, this condition can be fatal.


Usually, a history and physical performed by your healthcare provider will be enough to raise suspicion of ascites. To confirm the diagnosis, an ultrasound or CT scan may be ordered. And a small sample of ascitic fluid can be analyzed by withdrawing it through a needle inserted into the wall of the abdomen. This procedure is called diagnostic paracentesis.


Treating ascites begins with a diet low in sodium. If that is not sufficient, your healthcare provider may prescribe diuretics to help the kidneys excrete more sodium and water into the urine.

For patients who experience significant discomfort or those who cannot breathe or eat without difficulty, fluid may be removed through a procedure called therapeutic paracentesis, in which a needle is inserted into the abdomen. In rare cases, surgery is performed to reroute blood flow using a shunt and, in the rarest cases, liver transplantation is necessary.

4 Sources
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  2. Cleveland Clinic. Ascites.

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  4. Risson JR, Macovei I, Loock M, Paquette B, Martin M, Delabrousse E. Cirrhotic and malignant ascites: differential CT diagnosis. Diagn Interv Imaging. 2012;93(5):365-370. doi:10.1016/j.diii.2012.02.008

By Charles Daniel
 Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis.