Ascites must be differentiated from abdominal distension due to other causes such as obesity, pregnancy, gaseous distension of bowel, bladder distension, cysts, and tumours. Tense ascites may cause appreciable discomfort, difficulty in breathing, eversion of the umbilicus, herniae, and scrotal oedema. Rapid onset of ascites in patients with cirrhosis may be due to gastrointestinal haemorrhage, infection, portal venous thrombosis, or the development of a hepatocellular carcinoma. Ascites can also develop during a period of heavy alcohol misuse or excessive sodium intake in food or drugs. Ultrasonography is used to confirm the presence of minimal ascites and guide diagnostic paracentesis.
Successful treatment depends on an accurate diagnosis of the cause of ascites.
Paracentesis with analysis of ascitic fluid is the most rapid and cost effective method of diagnosis. It should be done in patients with ascites of recent onset, cirrhotic patients with ascites admitted to hospital, or those with clinical deterioration. The principal aim of treatment of symptomatic ascites in cirrhotic patients is to improve general comfort and quality of life. Most patients will respond to dietary sodium restriction and diuretic induced excretion of sodium and water, but other treatments are available for those who do not. Treatment does not necessarily improve the prognosis for patients with cirrhosis and may cause complications.