Ascites (Pet Mein Pani) Treatment in Indore

What is an Ascites?

Ascites (commonly known as pani in pet) is the accumulation of excess fluid in the abdominal cavity. The cavity is the space between the abdominal wall and organs such as the intestines, liver and stomach. Some fluid is normal, but when it builds up in large amounts the belly gets swollen, the skin gets tight and the person feels heavy and breathless.

Ascites is not a disease in itself. It is a warning that something in the body upsets the fluid balance, and the main task is to find that something. The most common cause of liver disease in adults but tuberculosis, heart failure, kidney disease, cancer and other conditions can also be responsible. The cause decides the treatment, and a swollen abdomen should never be treated only with home remedies.

Dr. Kriti Bansal examining abdominal fluid at Indore. The diagnosis of fluid buildup is established by examination, blood tests and analysis of the fluid itself, and treatment is planned to treat both the fluid and the source of the fluid. Treatment of ascites begins with determining the cause of fluid accumulation.

How Fluid Collects in the Abdomen

In liver cirrhosis, scar tissue blocks blood flow through the liver, raising the pressure in the portal vein that carries blood from the intestines to the liver. This high pressure forces fluid out of the blood vessels into the abdomen. At the same time, the damaged liver doesn’t make as much albumin, a protein that keeps fluid inside blood vessels. The kidneys react by holding onto salt and water, increasing the fluid load.

Under other conditions the mechanism is different. In either peritoneal tuberculosis or cancer, the lining of the abdomen is inflamed or invaded and leaks fluid. So in heart failure , the pressure in the veins is elevated and fluid backs up . The kidneys lose protein in the urine with nephrotic syndrome. Knowing how it works helps you choose the right test and the right medicines. Fluid in abdomen treatment in Indore depends on the cause of fluid i.e. liver pressure, infection or any other problem.

Symptoms of Ascites

Ascites generally occurs over weeks but may develop more rapidly in some conditions.

• Increasing abdominal distension: Clothes, belts and saree or trouser waistlines become tight and the navel may become flat or protrude.
• Quick weight gain: Weight goes up over days or weeks without eating more, sometimes with swollen feet.
• Abdominal discomfort: Feeling of fullness, heaviness or mild pain, possibly worse after eating.
• Early satiety and loss of appetite: Fluid puts pressure on the stomach so even small amounts of food will make you feel full.
• Shortness of breath: Large collections push up the diaphragm making it hard to breathe, especially when lying flat.
• Back ache and trouble bending: From the stretched abdominal wall.
• Swelling of ankles and legs: Often occurs with ascites, especially in liver and heart disease.
• Hernias: Increased pressure may cause a hernia in the navel or groin to develop or increase in size.
• Warning symptoms: Fever, severe abdominal tenderness, confusion or reduced urine output suggest infection of the fluid or kidney strain and require urgent care.

Causes of Ascites

Fluid can build up because of several conditions, and doctors categorize them based on whether pressure in the portal vein is elevated.

Increased portal pressure conditions

• Cirrhosis of liver: Most of the cases fall in this category. Cirrhosis can be caused by alcohol, hepatitis B and C, or fatty liver disease.
• Heart failure: When the right side fails, fluid backs up in the liver and causes edema.
• Blood clots in liver veins: Budd-Chiari syndrome and portal vein thrombosis block the flow of blood.
• Constrictive pericarditis: Scar tissue around the heart restricts the heart filling.

Conditions without elevated portal pressure

• Tuberculosis of peritoneum: Common in India, usually with fever and weight loss.
• Cancer: Cancers of the ovary, stomach, pancreas, colon or lymphoma can spread to the lining of the abdomen. Liver cancer can sometimes cause ascites.
• Nephrotic syndrome and kidney failure: Protein loss or excess fluid.
• Pancreatitis: Inflammation of the pancreas may leak fluid into the abdomen.
• Severe malnutrition: Low protein levels prevent the blood from holding fluid.
• Other rare causes such as underactive thyroid: These are looked for once the common causes have been excluded.

How Ascites is Diagnosed?

The doctor looks at the abdomen for a bulge in the flanks, shifting dullness and a fluid wave, and looks for evidence of liver disease such as jaundice, spider-like blood vessels and enlarged veins on the abdominal wall. Ultrasound can detect fluid, even in small amounts, and can also show the liver, spleen, portal vein and any growths.

The most informative test is the diagnostic paracentesis. A small sample of fluid is taken with a thin needle inserted into the abdomen under local anesthetic. In the lab we test for protein, albumin, cell count, culture, ADA for TB, and cytology for cancer cells. The serum-ascites albumin gradient (SAAG) is calculated by comparing albumin in blood and in fluid. A gradient of 1.1 g/dL or higher indicates portal hypertension as in cirrhosis or heart failure, while a lower gradient indicates tuberculosis, cancer or similar causes.

Other tests are liver and kidney function, blood counts, clotting tests, viral markers for hepatitis, echocardiogram if the heart is suspected, endoscopy to look for varices in the food pipe, CT scans and in selected patients biopsy of the peritoneum through laparoscopy. Generally, an ascites specialist in Indore will test the fluid itself since its features narrow down the cause.

Treatment of Ascites

The treatment is based on the type of ascites and is modified over time based on response. Abdominal fluid treatment in indore is regularly reviewed and doses and diet are adjusted according to response.

Dietary salt restriction

If you have ascites from liver disease, the first step is to restrict the amount of sodium you eat to about two grams a day (about five grams of table salt). Pickles, papad, namkeen, packaged snacks, processed cheese, sauces and ready-to-eat noodles are full of hidden salt. There is no need to restrict water unless the blood sodium is very low. Patients should also maintain adequate protein and calorie intake as malnutrition worsens liver disease.

Diuretic medications

Spironolactone (often with furosemide) causes the kidneys to excrete salt and water. The doses are gradually increased, aiming for a weight loss of about 0.5 kg per day in patients without leg swelling, and up to 1 kg per day when there is also swelling. Blood tests are regularly repeated to check sodium and potassium levels and kidney function, and doses are reduced if kidney function deteriorates or if the patient becomes dizzy or confused.

Therapeutic paracentesis

If the ascites is large and causes tension or breathlessness it is drained through a tube inserted into the abdomen. If more than five liters is removed albumin is given to protect circulation and kidneys. This is done in a hospital and usually gives quick relief of pressure.

Treating infection of the fluid

Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid in the absence of a perforating source. It is identified when the fluid has more than 250 neutrophils per cubic millimeter. They are given IV antibiotics and albumin. Patients who have had SBP, or who have very low fluid protein, may be placed on long-term prophylactic antibiotics.

Refractory ascites

Fluid comes back quickly in a few patients despite diet and medicines or diuretics cannot be tolerated. Large volume paracentesis with albumin, TIPS procedure to create a channel to reduce portal pressure, tunneled drain in selected palliative situations and assessment for liver transplantation which is the definitive treatment for late stage cirrhosis are all options.

Tackling the root cause

Tuberculosis related ascites is treated with anti-tubercular drugs. Heart failure calls for heart medications and fluid control. Nephrotic syndrome is treated by kidney doctors. The treatment of cancer-related ascites depends on the type of cancer. Key for cirrhosis are stopping alcohol, treating hepatitis, managing fatty liver and avoiding medicines that harm the kidney like anti-inflammatory painkillers.

Complications Linked to Ascites

Other complications include hernias, breathing problems, fluid in the chest (hepatic hydrothorax), electrolyte imbalances, and hepatorenal syndrome, a serious form of kidney failure that occurs in advanced liver disease. Ascites is also a sign that cirrhosis has reached a stage that needs closer monitoring, so these patients are followed routinely and evaluated for transplant suitability when appropriate.

Monitoring and Home Care

Weigh yourself every morning after you have passed urine, using the same scale and wearing similar clothing and enter the weight in a diary. Weekly measurements of the belly girth at the navel will also be helpful. Report any sudden gain of more than 2 kg in few days, reduced urine, fever, vomiting, abdominal pain, confusion or black stools. Do not drink alcohol at all and do not take painkillers without medical advice. Elevating the head of the bed and eating small frequent meals may help relieve breathlessness and early satiety. These home measures work in conjunction with the medical treatment and not as a substitute to it. 

A Low-Salt Eating Plan That Works in Indian Kitchens

In a flavor-based cuisine, cutting down on salt is hard, but possible with a few changes. Use measured salt while cooking at home and add at the table and not while cooking. Use lemon juice, ginger, garlic, cumin, coriander, black pepper, curry leaves, mint and tamarind to enhance taste. Avoid pickles, papad, salt chutneys, salted nuts, farsan, ready made sauces, packet soups, canned foods, cheese, salted butter and bakery products. Reading the sodium content on packaged food is helpful.
Fresh vegetables, fruits, dal, rice, rotis, milk, curd in moderate quantities and home cooked sabzi are inherently low in sodium. If you take spironolactone, check with your doctor before you use a salt substitute that contains potassium. It may increase your potassium. Protein-rich meals like eggs, paneer, dal, soya and fish or chicken for non-vegetarians are encouraged to protect muscles and a late evening snack avoids long fasting overnight.

Ascites in Special Settings

• Tuberculous ascites: Often associated with fever and weight loss, responds to anti tubercular treatment and salt restriction is not the main therapy.
• Malignant ascites: Fluid is drained for comfort and management depends on the type of cancer. A drain may be left in place for repeated removal.
• Cardiac ascites: This is treated with medicines for heart failure and weight and salt are watched closely.
• Pancreatic ascites: Treated by correcting the pancreatic leak sometimes with endoscopic procedures.
• Chylous ascites: This is milky fluid from lymphatic leakage and is treated with a special fat-modified diet.

What to Expect During Paracentesis

The procedure is performed with the patient reclined at a slight angle. The skin over the lower abdomen is cleaned and a local anesthetic injected. A thin needle or small tube is passed into the fluid, using ultrasound guidance if required. Diagnostic sample takes only few minutes. The fluid is drained therapeutically over a period of one to several hours, with monitoring of the patient’s blood pressure. Patients usually go home the same day or the day after and a small dressing is applied over the site. “Very rarely there is leakage of fluid, small bleeding or infection and the team looks for these.

Why Choose Dr. Kriti Bansal?

Abdominal fluid is a clue to be followed, Dr. Kriti Bansal says. It often tells you if the source is the liver, tuberculosis, the heart or something else, and avoids just treating the swelling itself. Checking the fluid in the lab itself.

She teaches patients and their families how to track their daily weight, waist size and salt intake at home, with real-life examples of low-salt Indian food so that the plan can be incorporated into daily cooking. Regular blood tests are done to monitor your kidneys and electrolytes and adjust the doses of diuretics.

Patients looking a gasteroenterologist in Indore for ascites will get diagnosis, fluid drainage when needed and follow-up for the liver all under one roof.

Book a Consultation

Phone: +91-7610102710
Email: drkritigastro@gmail.com