Ascites is the accumulation of excess fluid within the abdominal cavity.
It can be caused by tumor cells in the abdomen, tumour invasion resulting in compression of the portal and venous lymphatic systems — also by decreased protein in the bloodstream, liver disease, or congestive heart failure.
Severe ascites is associated with poor prognosis.
10% of all cases of ascites are caused by cancer. 15% to 50% of all cancer patients will develop ascites. It is more common with certain tumors, e.g., 30% of ovarian cancer patients have ascites on presentation and 60% at death. Endometrial, breast, colon, stomach, and pancreatic cancers also have a high incidence of ascites.
Assessment
Onset, severity, alleviating and aggravating factors, associated symptoms (e.g., dyspnea, constipation, anorexia, early satiety, nausea, vomiting, or esophageal reflux), altered functional abilities, and psychological concerns.
Physical examination.
Inspect the abdomen for bloating, distension, or bulging flanks. Auscultate for bowel sounds. Percuss to determine the presence and volume of fluid (there must be at least 1500 mL of fluid before dullness occurs with percussion). Palpate for abdominal tenderness.
Interventions
- Manage related symptoms, such as constipation, nausea, and/or dyspnea.
- Provide paracentesis for recurrent ascites. Despite the potential for fluid volume depletion, protein loss, and the possibility of rapid fluid re-accumulation, symptomatic relief takes priority. Persons who require frequent paracentesis may benefit from the insertion of a permanent catheter.
See reference for details. Adapted from 99 Common Questions (and more) about Hospice Palliative Care. Edmonton Zone Palliative Care Program. Alberta Health Services, Edmonton, Canada. Internet. Accessed on May 23, 2016.
