# Ascites --- **Ascites** is a complication of liver disease which results in buildup of fluids [[fluid volume deficit|third spacing]] in the [[peritoneum|peritoneal cavity]]. It is the most common complication of [[cirrhosis]]. The exact pathways for ascites is not exactly understood but they have a pretty good idea. There are a few factors that contribute to the interstitial fluid leaking out into the body cavity: - [[hepatic portal system|portal hypertension]] increases the hydrostatic pressure pushing fluids out of the blood vessels - the [[renin-angiotensin-aldosterone system|RAAS]] system is activated due to the decrease in available water in the vasculature, which produces aldosterone. This has several knockoff effects: - aldosterone retains water by retaining salt - more water is retained (in the kidneys) due to the aldosterone, which is then lost to the peritoneal cavity - and another kicker: the ADLO is broken down in the liver, so it stays around even longer - low levels of [[albumin]], which are produced in the liver, which increases the [[osmosis|osmotic pressure]] to keep fluids in the blood vessels - all the water retained from the ADLO escapes into the surrounding tissues So there is increased pressure pushing out and decreased pressure pushing in. ## Signs & Symptoms The signs and symptoms of ascites have to do with the increased intraperitoneal pressure that the buildup of fluid puts on the other organs around. - [[pleural effusion]] (called "hepatic hydrothorax") - dyspnea - the fluid doesn't have anywhere to go, it goes into the lungs - abdominal [[compartment syndrome]] - decrease in kidney function - striae and distended abdominal veins - [[body fluids|fluid volume]] imbalances - even [[fluid volume deficit]], because the vasculature is dry even though all the water is "in" the body - [[electrolyte imbalances]] ## Diagnostic Tests The "Fluid Wave". Someone puts there hand karate chop down in the middle of the abdomen and the provider can tap one side of the ## Treatment - low salt/fluids - diuretics - bed rest - RAAS is activated when upright - **paracentesis**, which is a procedure done to drain the fluid in the abdomen with a big old needle - you can take a couple liters to up to 10+ liters - it's important to monitor electrolytes and albumin after a paracentesis - sometimes you will replace albumin/electrolytes afterwards - the fluid will likely be tested to make sure it doesn't spontaneously develop an infection ## Nursing Considerations Keep an eye on/track: - abdominal girth - daily weights For paracentesis: - have patient empty their bladder prior to the procedure to reduce the risk of rupturing the bladder - monitor patient status during paracentesis for vitals, especially BP ___