Ascites due to liver cirrhosis is a common complication in the late stage of liver cirrhosis. Ascites caused by liver cirrhosis is referred to as cirrhosis-associated ascites, commonly known as hepatic ascites. In the advanced stage of liver disease, when portal hypertension or hypoalbuminemia occurs, it manifests as hepatic ascites, with symptoms including abdominal distension. As the ascites increases, the abdominal distension becomes progressively more severe, and even shiny abdominal skin may be observed. Some patients may also experience lower limb edema.

When hepatic ascites is complicated by secondary infection, patients may present with symptoms of spontaneous bacterial peritonitis, such as abdominal pain and fever. On physical examination, the patient's abdomen appears significantly distended, resembling a frog belly. Percussion of the abdomen reveals dullness, similar to an unripe watermelon. In some cases, pressing on the abdomen may even cause pitting edema.

Common symptoms of cirrhotic ascites. In the late stages of cirrhotic ascites, when the ascites volume is small, there are usually no obvious visible changes, but a large amount of ascites can cause abdominal distension. Patients with cirrhotic ascites generally have poor overall nutritional status, dry and rough skin, a dull and dark complexion, low energy, emaciation, and weakness. In the late stages, severely ill patients are extremely debilitated and may even be bedridden. They often exhibit manifestations of nutritional deficiencies, such as anemia, glossitis, angular cheilitis, night blindness, polyneuritis, and edema. Those with massive ascites and an abdomen swollen like a drum may experience shortness of breath even with slight movement. Percussion of the abdomen reveals dullness, and splashing sounds can be heard inside the abdomen. When acute peritonitis occurs with cirrhotic ascites, abdominal muscle rigidity, tenderness, and rebound tenderness are present, with weakened or absent abdominal breathing. The patient experiences unbearable abdominal pain accompanied by fever. When inflammatory ascites causes adhesions within the abdomen, forming compartments, although there is a large amount of ascites and abdominal distension, there may be no obvious shifting dullness, or the shifting dullness on both sides may be asymmetrical, leading to poor treatment outcomes. In female patients, it is also necessary to differentiate from giant ovarian cysts. In cases of ascites caused by abdominal tumors, localized bulging or palpable masses may sometimes be visible in the abdomen.

How to detect cirrhotic ascites in a timely manner?

1. Patients may experience fatigue, easy tiredness, decreased physical strength, and a few patients may also present with facial pigmentation.

2. Patients may develop chronic digestive symptoms, such as abdominal distension, possibly accompanied by constipation, diarrhea, or dull pain in the liver area, which worsens after exertion. This is one of the most common early symptoms of cirrhosis.

3. In a minority of patients, spider angiomas may appear, with mild to moderate hepatomegaly. This is more commonly observed in patients with alcoholic cirrhosis and is generally non-tender. The spleen may be normal or slightly enlarged.

Treatment principles: The principles for treating cirrhosis include the following: first, target the underlying cause; second, alleviate portal hypertension; third, manage symptoms as they arise, monitor albumin levels, promptly correct hypoalbuminemia, and adjust diuretic use appropriately. The management of cirrhotic ascites also requires systematic oversight.

Patients with cirrhotic ascites must promptly seek treatment from a professional doctor at a reputable hospital to prevent the condition from worsening.