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Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).

A person with ascites usually has severe liver disease. Ascites is caused by high pressure in the blood vessels of the liver (portal hypertension) and low albumin levels.

Disorders that may be associated with ascites include:

• Cirrhosis
• Clots in the veins of the liver (portal vein thrombosis)
• Congestive heart failure
• Constrictive pericarditis
• Hepatitis
• Liver cancer
• Nephrotic syndrome
• Ovarian cancer
• Pancreatitis
• Protein-losing enteropathy

A physical examination may reveal a swollen abdomen or belly.

Paracentesis may be performed. This procedure involves using a thin needle to pull fluid from the abdomen. The fluid is tested in various ways to determine the cause of ascites.

The condition that causes ascites will be treated, if possible.

Treatment may include:

• Diuretics, usually spironolactone (Aldactone) and furosemide (Lasix), which help remove the fluid
• Antibiotics, if an infection develops
• Limiting salt in the diet (no more than 1,500 mg/day of sodium)
• Avoiding drinking alcohol

Procedures used for ascites that do not respond to medical treatment include:

• Placing a tube into the area to drain the ascites
• Transjugular intrahepatic portosystemic shunt (TIPS)

• Spontaneous bacterial peritonitis (a life-threatening infection of the ascites fluid)
• Hepatorenal syndrome
• Other complications of liver cirrhosis

Anyone who has ascites and develops new abdominal pain and fever should contact their health care provider immediately.

Heidelbaugh JJ, Sherbondy M. Cirrhosis and chronic liver failure: part II. Complications and treatment. Am Fam Physician. 2006;74:767-776.

Salerno F, Cammà C, Enea M, Rössle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007;133:825-834.

Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.

Updated by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.