Fluid Accumulation Can Cause Heartburn

On Call

April 29, 1997|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

Over the past several weeks my husband noticed gradually increased swelling in his stomach. According to his doctor, the swelling is due to fluid. I would like to know what could cause this and what can be done about it?

Ascites, the medical term for an accumulation of fluid within the abdominal (peritoneal) cavity, may progress slowly and not he noticed for several months because it usually causes no pain or other symptoms during the early stages.

The first hint may come when a belt or clothing feels tight. A large amount of fluid can cause heartburn, indigestion, and even shortness of breath by pushing up the diaphragm so as to decrease the air space within the lungs. The presence of small amounts of fluid may only be found by a CT scan or an ultrasound study.

The most common causes of ascites are cirrhosis of the liver, heart failure and metastatic cancer. Less often ascites is due to infections within the abdomen, including tuberculosis, pancreatitis, low levels of thyroid hormone (hypothyroidism), and nephrosis (a kidney disorder characterized by the loss of large amounts of protein in the urine).

Fluid accumulations at other sites in the body, called edema, may accompany ascites in patients with cirrhosis, heart failure, hypothyroidism or nephrosis.

Although ascites is generally limited to the abdomen, in about 10 percent of cases, fluid may pass through the diaphragm and enter the pleural space around the right lung.

Insertion of a needle into the abdomen to withdraw some of the fluid into a syringe is needed to determine the cause by examining the fluid for protein, cells and bacteria.

Cancer can be identified by the presence of malignant cells in the fluid but may require biopsy of the membrane (peritoneum) lining the abdominal cavity.

Detection of bacteria allows initiation of appropriate treatment for an infection.

Salt restriction and diuretics (medications that promote the loss of sodium in the urine) are the mainstays of treatment for ascites due to cirrhosis or heart failure. If these measures do not control the ascites, it may be necessary to periodically have physicians remove large amounts of fluid with a needle.

In some cases, doctors insert a peritovenous shunt, a long tube connecting the fluid within the abdomen to a jugular vein or to the right atrium of the heart. The tube is equipped with a one-way "valve" that opens and allows drainage of fluid when the pressure within the abdomen is high enough. This approach can, unfortunately, be accompanied by dangerous complications.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 4/29/97

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