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There is a distinction between patients who develop ascites because of liver disease and cirrhosis, and those who develop it because of inflammation of the peritoneum because of cancer. Liver disease tends to be relatively painless, while cancer patients experience significant amounts of pain.
Otherwise, the symptoms are similar. There is swelling of the abdomen to accommodate the fluid buildup. This may make it difficult for the diaphragm (the flat muscle that separates the chest form the abdomen) to assist with breathing, causing shortness of breath.
While a tense abdomen filled with fluid is easy to recognize, initially, the amount of ascites fluid may be small and difficult to detect. As the amount of fluid increases, the patient may complain of a fullness or heaviness in the abdomen. It is often the signs of the underlying disease that initially brings the patient to seek medical care.
In cirrhosis of the liver, not only does fluid accumulate in the abdominal cavity, but there may be leg swelling, easy bruising, enlargement of the breasts, and confusion due to encephalopathy (encephalo= brain + pathy=disorder).
If the ascites is due to heart failure, there may be shortness of breath as well as leg swelling (edema). The shortness of breath tends to be worse with activity and with lying flat (orthopnea). Patients with ascites due to heart failure tend to waken in the middle of the night, with paroxysmal nocturnal dyspnea (dys= abnormal + pnea= breathing).
Those who have spontaneous bacterial peritonitis (an infection of the peritoneum) develop abdominal pain and fever.
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