How Cirrhosis From Chronic Hepatitis Can Cause Ascites

Ascites is extra fluid in the space between the tissues lining the abdomen and the organs in the abdominal cavity (such as the liver, spleen, stomach). This space between the tissues is called the peritoneal cavity. One layer of tissue lines the inside of the belly wall and the other layer of tissue lines the outside of the organs.

A woman holding stomach in pain
Science Photo Library / Getty Images

These two layers are actually one continuous layer that sort of wraps around or doubles back on itself, but the important idea is that there is space between these layers which is normally filled with a small amount of fluid (called peritoneal fluid) that helps lubricate the organs as they move around inside your belly. Sometimes, diseases can cause an excess of fluid to accumulate in the peritoneal cavity. This extra fluid causes the condition of ascites.

How Does Liver Disease Cause Ascites?

Ascites is caused by many diseases, including liver disease, congestive heart failure, nephritis, infection, and cancer, to name some of the most common. One of the complications of cirrhosis, a disease caused by chronic hepatitis, is portal hypertension, which is an increase of pressure in the portal vein system.

One of the functions of the liver is to remove certain kinds of wastes from the body's blood supply. The liver is supplied by blood from the heart through the hepatic artery and by blood from the gut (the digestive system) and the pancreas through the portal vein.

When cirrhosis develops, the portal vein system cannot filter effectively through the cirrhotic and nodular liver which results in increased pressure of the blood flowing through the digestive system. This increased pressure forces fluid (made up of water and proteins) out of the blood vessels which collect in the abdominal cavity.

The complete cause of ascites is complex and involves several systems. One of those systems is the kidneys, which play a large role by conserving water. As fluid leaks from the liver, the blood volume is reduced. In order to compensate, the kidneys begin to retain sodium which conserves water and maintains the normal level of blood.

Though the most common cause of ascites is cirrhosis, other reasons need to be considered. One way the doctor can do this is by removing a sample of fluid using a needle and sending it to a lab for testing. Clinicians can make presumptive diagnoses just by looking at the appearance of the fluid. For example, "cloudy" suggests an infection while "bloody" can suggest a tumor or a traumatic tap (which is inside bleeding at the site of a needle puncture).

Why Is Ascites a Problem?

Ascites usually leads to respiratory problems (such as shortness of breath), malnutrition, and extreme fatigue. Acidic fluid can also be a potential source of infection.

Diagnosis

Doctors who suspect ascites will look for bulging areas in the abdomen that sound consistently dull when tapped by the fingers. An ultrasound helps clarify the results of the physical examination of people with mild or subtle ascites.

Treatment

Ascites caused by liver disease is impossible to cure because it would require removing the underlying cirrhosis. However, mild ascites can be effectively managed by restricting sodium in the diet to less than 5 to 6 grams each day. Achieving this target amount is relatively difficult because it usually requires a significant change in eating habits, such as avoiding most processed foods and most restaurant-prepared foods.

For moderate and severe ascites, your doctor will probably prescribe a diuretic medication which causes you to increase your urination. If your ascites isn't controlled by diet or medication, your doctor might choose a procedure called paracentesis (which uses a needle to collect fluid) or use a shunt (TIPS, transjugular intrahepatic portosystemic shunt) to help drain the fluid.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Moore CM, Van Thiel DH. Cirrhotic ascites review: Pathophysiology, diagnosis and managementWorld J Hepatol. 2013 May;5(5):251-263. doi:10.4254/wjh.v5.i5.251

  2. Rudralingam V, Footitt C, Layton B. Ascites mattersUltrasound. 2017 Dec;25(2):69-79. doi:10.1177/1742271X16680653

  3. Aithal GP, Palaniyappan N, China L, et al. Guidelines on the management of ascites in cirrhosisGut. 2020 Dec;70(1):9-29. doi:10.1136/gutjnl-2020-321790

  4. Pedersen JS, Bendtsen F, Møller S. Management of cirrhotic ascitesTherapeutic Advances in Chronic Disease. 2015 Apr;6(3):124-137. doi:10.1177/2040622315580069

  5. Huang LL, Xia HH, Zhu SL. Ascitic fluid analysis in the differential diagnosis of ascites: focus on cirrhotic ascitesJ Clin Transl Hepatol. 2014 Mar;2(1):58-64. doi:10.14218/JCTH.2013.00010

  6. Wittmer VL, Lima RT, Maia MC, et al. Respiratory and symptomatic impact of ascites relief by paracentesis in patients with hepatic cirrhosisArquivos de Gastroenterologia. 2020 Feb;57(1):64-68. doi:10.1590/s0004-2803.202000000-11

  7. Szkodziak P, Czuczwar P, Pyra K, et al. Ascites Index - an attempt to objectify the assessment of ascitesJ Ultrason. 2018 Jun;18(73):140-147. doi:10.15557/JoU.2018.0020

  8. Haberl J, Zollner G, Fickert P, Stadlbauer V. To salt or not to salt?-That is the question in cirrhosisLiver Int. 2018 Apr;38(7):1148-1159. doi:10.1111/liv.13750

  9. Rudler M, Mallet M, Sultanik P, Bouzbib C, Thabut D. Optimal management of ascites. Liver International. 2020 Feb;40(1):128-135. doi:10.1111/liv.14361

Additional Reading
  • Bacon BR. Cirrhosis and Its Complications. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008. 1978-1979.
  • Glickman RM, Rajapaksa R. Abdominal Swelling, and Ascites. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008. 266-268.