What Are the Symptoms of Ascites?

Ascites is the most common of the three major complications associated with cirrhosis; approximately 60% of patients develop ascites within 10 years after diagnosis of cirrhosis. Once ascites is detected, the risks of hyponatremia, hepatorenal syndrome, and spontaneous bacterial peritonitis increase significantly. Epidemiological data indicate that about 15% of patients with ascites die within one year, and 44% die within five years.

Symptoms of Ascites

Liver transplantation is recommended for patients with ascites. Ascites due to cirrhosis typically develops insidiously; some patients experience recurrent episodes. The primary manifestations include abdominal distension and increased abdominal girth, often accompanied by prominent gastrointestinal symptoms such as fatigue, anorexia, nausea, aversion to greasy foods, and dull pain or discomfort in the hepatic region. Additional signs may include jaundice, epistaxis, gingival bleeding, and bilateral lower-limb edema.

In severe cases, pleural effusion may develop, leading to oppressive symptoms including chest tightness, palpitations, shortness of breath, and tachypnea. When generalized abdominal distension occurs, percussion of both flanks should be performed. An increase in flank dullness compared with normal, or detection of a fluid–air level on percussion over the posterior abdomen while the patient is supine—higher than expected—warrants assessment for shifting dullness.

The presence of shifting dullness suggests approximately 1500 mL of ascitic fluid. In its absence, the likelihood of clinically significant ascites is less than 10%.

1. Grade 1 ascites: Minimal ascites detectable only on abdominal ultrasound.

2. Grade 2 ascites: Moderate ascites with moderate abdominal distension.

3. Grade 3 ascites: Large-volume ascites with marked abdominal distension.

The above provides an overview of the symptoms associated with ascites. We hope this information is helpful to you.