Ascites

What is ascites?
Ascites (pronounced ah-site-eez) is the abnormal accumulation of fluid in the abdomen.  This extra fluid causes the belly to become swollen and distended.  Cancer accounts for approximately 10% of all cases of ascites and can occur when cancer has spread to the abdominal lining (peritoneum) from its original site.  Most cases of cancer-related ascites occur in individuals with cancers of the breast, ovaries, colon, stomach or pancreas. Ascites may be present at any time during the pancreatic cancer journey but is especially common in patients with advanced metastatic pancreatic cancer.

Possible Causes of Ascites

  • If the cancer has spread to the abdominal lining, the lining can become irritated.  To soothe this irritation, the peritoneum produces fluid which builds up within the abdomen.
  • If the cancer has spread to the liver or the portal vein (the vein that carries blood to the liver), blood pressure can rise within the liver and impair circulation, causing a build-up of fluid in the abdomen.
  • If the liver is damaged it may produce less blood protein. This disrupts the body’s fluid balance, causing fluids to collect in body tissues including the abdomen.
  • If the cancer blocks the lymphatic system, excess fluid cannot be efficiently drained and results in fluid build-up in the abdomen.

Signs and Symptoms of Ascites
Small amounts of fluid in the abdomen usually produce no symptoms.  However, as the amount of fluid increases, the abdomen swells, the skin stretches tightly across the abdomen and the navel becomes flat or even pushed out.  This puts pressure on the stomach and lungs and can lead to other symptoms.  The following may be signs and symptoms of ascites:

  • Abdominal swelling, discomfort and increased waist size
  • Difficulty breathing and shortness of breath
  • Decreased appetite and a sense of fullness
  • Abdominal pressure or pain
  • Indigestion
  • Weight gain
  • Fatigue
  • Constipation
  • Nausea
  • Ankle swelling

Tell your doctor or another member of your healthcare team if you develop these problems or if you have been treated for ascites and these symptoms have returned.

Treatments for Ascites
The accumulation of fluid in the abdomen can be controlled for most patients in several ways:

Treating the Tumor – Effective treatment of the cancer through chemotherapy or surgery may reduce the fluid build-up in the abdomen.

Diuretics – Diuretics (water pills) cause the kidneys excrete more water into the urine which may slow the buildup of fluid in the abdomen.

Paracentesis – In moderate to severe cases of ascites, the fluid can be drained to relieve discomfort with a procedure called paracentesis.  Paracentesis involves inserting a needle attached to a tube into the abdominal cavity and slowly draining the excess fluid.  The length of time required to remove the excess fluid varies depending on the amount that needs to be removed.  Sometimes a small amount of fluid can be drained in an outpatient setting with no hospital stay required.  However, if a large amount of fluid needs to be removed, the patient may need to be hospitalized for the procedure.

Undergoing paracentesis can temporarily reduce symptoms, but the excess fluid in the abdomen tends to return at which time paracentesis may be repeated.  Some patients who produce large amounts of fluid build-up may benefit from the insertion of a catheter that drains the ascites continuously.

Comfort Measures – While paracentesis can reduce symptoms for a period of time, fluid build-up typically returns and patient care should focus on measures to facilitate fluid loss and decrease symptoms.  Common problems with recurrent ascites are the swelling of the legs, breathing difficulty, and blockage of the intestine.  Resting in a reclined position with the feet elevated alleviates pressure on the internal organs, improves blood flow returning from the lower extremities, and increases fluid loss.

Because the accumulated fluid is often very heavy, it can impair movement within the bowel.  Therefore, it is important to prevent or manage constipation, especially in a patient who is taking opioids for pain management or has other risks for constipation.  Ascites can also slow the movement of food leaving the stomach leading to nausea and vomiting.  Proper positioning may help nausea as the stomach empties toward the right and many patients are less prone to nausea when lying on their right side.  In addition, medications that promote upper gastrointestinal movement are also helpful for alleviating this problem.  Patients should consult with the doctor to prevent and manage symptoms.

 

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