Ascites - Ascites

Ascites

Ascites (commonly known as ascites) is a pathological accumulation of fluid in the abdomen. The human body consists to a large extent of fluid in the cells and outside the cells (intra- and extracellular). This distribution of the liquid is kept in equilibrium by a complex system. If the equilibrium is disturbed by pathological processes, fluid accumulation occurs in the tissue - in the case of ascites in the abdomen. Usually there is little or no liquid there.

Ascites can develop in many different diseases. Examples are cirrhosis of the liver, impaired kidney function or right heart failure. A pathological change in the peritoneum, for example due to infections or cancer, also leads to this.

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• What are the causes of ascites?
• What are the symptoms?
• How is the diagnosis made?
• How is ascites treated?
• Whom can I ask?
• How will the costs be reimbursed?

What are the causes of ascites?

In certain illnesses, the accumulation of fluid is caused by a lack of protein and the resulting increased penetration of the blood vessels (e.g. liver disease or protein malnutrition) or fluid retention (e.g. heart failure). In addition, disorders of the lymphatic system lead to ascites. The kidneys play an essential role in the body's fluid balance. As a result of kidney diseases or damage, fluid can accumulate in the body.

An ascites occurs, for example:

• Cirrhosis of the liver,
• Heart failure,
• Peritonitis (inflammation of the peritoneum): e.g. in tuberculosis or other bacterial infections,
• Alcohol hepatitis,
• Budd-Chiari syndrome (abnormal drainage of blood from the liver veins)
• sinusoidal obstruction syndrome (occlusions of the smallest blood vessels - sinusoids and venules - in the liver),
• Cancer diseases: e.g. metastases of the peritoneum (peritoneal metastases), liver cancer,
• nephrotic syndrome (excessive protein excretion in the urine due to kidney disease),
• Malnutrition (lack of protein),
• Pancreatitis (inflammation of the pancreas) and many other diseases.

What are the symptoms?

Symptoms include:

• Increase in waist size. A very strong enlargement is colloquially known as a "drum belly" - visible in a distended stomach and tense skin;
• Increase in body weight;
• possibly difficult breathing;
• possibly abdominal pain with pronounced ascites;
• hernias can also occur.

How is the diagnosis made?

In the course of the diagnosis, medical history and complaints are recorded. For example, illnesses and lifestyle are essential. Ascites occurs especially in people who already suffer from a (serious) illness. Often this is already known.

In addition, the following are carried out:

• Physical examination including ultrasound,
• Laboratory tests (e.g. liver values, kidney function, etc.),
• Ascites puncture (removal of fluid) and examination of the samples in the laboratory.

Depending on the underlying disease, further examinations may be necessary.

How is ascites treated?

Ascites is treated with one or more of the following measures, depending on the cause:

• Change in diet: e.g. reducing salt in the diet or protein-rich diet
• Restriction of the amount of drinking
• Water medicines (diuretics)
• bed rest

Treatment of the underlying disease is also essential for therapy.

An intervention can possibly also be carried out. Liquid can be removed from the abdomen through a puncture with a hollow needle. The creation of a peritoneovenous shunt (PVS) is also an option at a very advanced stage. This creates a connection between the abdomen and the superior vena cava (superior vena cava). This allows fluid from the abdomen to be returned to the blood system.

Whom can I ask?

Depending on the cause, doctors from various disciplines and specializations are involved in the diagnosis and therapy process, e.g. for general medicine, especially in primary care, internal medicine (gastroenterology and hepatology, cardiology, oncology, infectious medicine), intensive care medicine.

In general, if you have symptoms such as severe shortness of breath, increased breathing, accelerated breathing, sudden pain in the chest area, severe pain, fear and bluish discoloration of the lips / skin or loss of consciousness, etc., the ambulance or the European emergency number should be contacted immediately (emergency number 144 or 112)!

How will the costs be reimbursed?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. You can find more information under What does a hospital stay cost? Your resident doctor or outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see What does a hospital stay cost, a doctor's visit: Costs and deductibles.

For certain non-drug treatments (e.g. physical therapy) - in some cases only when a certain level has been reached - approval from the health insurance provider may be required.

For certain services (e.g. medical aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “prescription”. For more information about the respective provisions, please contact your health insurance provider, which you can find on the social security website, for example.