The list of causes of ascites begins with the liver. Regardless of the reason for liver failure, a malfunctioning liver cannot make enough protein to maintain oncotic pressure to keep fluid in the circulatory system.
Causes of ascites due to liver problems include:
- Cirrhosis describes a form of liver failure in which liver tissue that is damaged is replaced by scar tissue. As more liver tissue is lost is progressive liver failure occurs. Alcoholic liver disease or alcoholic hepatitis (hepar=liver +itis=inflammation), viral hepatitis (B or C), and fatty liver disease are the most common causes for cirrhosis.
- Acute liver failure can result in ascites. This may be due to any acute injury to liver cells including adverse reactions to medications or drug abuse (for example, liver failure is the major consequence of acetaminophen overdose).
- Budd-Chiari syndrome is caused by the blockage of the hepatic veins (those that drain the liver). This causes the triad of ascites, abdominal pain, and hepatosplenomegaly (enlargement of the liver and spleen).
- Cancer that has metastasized or spread to the liver can also be the source of ascites.
Other causes of ascites include:
- Heart failure is the inability of the heart muscle to adequately pump the fluid within the blood vessels. This can cause a variety of problems, but most notably, fluid backs up into the lungs and other organs causing them to fail. This water overload can cause leakage into the peritoneal cavity and the formation of ascites.
- Nephrotic syndrome, in which kidney damage causes protein to leak into the urine, decreases oncotic pressure and may result in ascites.
- Disorders of the pancreas can result in ascites in a variety of ways. Acute pancreatitis (inflammation of the pancreas) can cause fluid accumulation as part of the inflammatory response. Chronic pancreatitis can result in malnutrition, leading to decreased total body protein, loss of oncotic pressure, and ascites. Pancreatic cancer can cause direct fluid loss.
- Direct irritation of the peritoneum can cause it to leak fluid as part of the inflammation process. This irritation may be due to amalignancy (cancer) or infection.
- Diseases of the ovary can be associated with ascites. Cancer of the ovary has no initial symptoms, and many women will have the diagnosis made because they develop ascites. Meigs syndrome is a benign tumor of the ovary called a fibroma that presents with ascites and pleural effusion (fluid in the cavities surrounding the lungs). The hard surface of anovarian tumor may cause significant irritation of the peritoneum, causing it to leak fluid.
- Ascites is found uncommonly inhypothyroidism (low thyroid function). Usually the hypothyroidism has been untreated for a prolonged period of time, and the ascites resolves when thyroid levels in the body return to normal.
Medically Reviewed by a Doctor on 5/23/2014
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