Ascites is defined as excessive fluid built
up within the peritoneal cavity. The abdominal organs
and the abdomen itself are lined with membranes called the
peritoneum. Between these two linings is a space referred to
as the peritoneal cavity. In Lupus Nephritis, fluid can
build up in the peritoneal cavity. This is called Lupus
Nephritis Ascites.
Smaller abdominal fluid amounts usually do not produce symptoms.
But, larger accumulations can cause:
- rapid weight gain
- abdominal discomfort and distention
- shortness of breath and actual dyspnea, or difficulty
breathing
- swollen ankles
Severe cases of ascites can result in the retention of literally
gallons of liquid in the peritoneal cavity. If fluid retention is
severe, the abdomen can become swollen and painful. Breathing can be
affected as the fluid-filled peritoneal cavity presses upon the
diaphragm, a very necessary component of respiration.
Treatments
Reclining minimizes the amount of salt the kidneys absorb, so
treatment generally starts with bed rest and a low-salt diet.
Urine-producing drugs (diuretics) may be prescribed if initial
treatment is ineffective. The weight and urinary output of patients
using diuretics is normally carefully monitored, often on a daily
basis. This scrutiny involves watching for signs of:
- Hypovolemia (massive loss of blood or fluid) that can often
result in drastic drops in blood pressure.
- Azotemia (abnormally high blood levels of nitrogen-bearing
materials).
- Potassium imbalance that can result in cardiac arrhythmia.
- High sodium concentration. Sodium should be restricted from
the diet as much as possible.
Because of the discomfort and respiratory difficulty
moderate-to-severe accumulations of fluid can produce, fluid
removal, or paracentesis, is often the treatment of choice.
Paracentesis involves the extraction of fluid from the abdominal
cavity with a needle that is usually inserted into the peritoneum
under local anesthesia. This is a relatively safe and painless
method of relieving fluid build-up. It is considered safer than
diuretic therapy, resulting in fewer complications and requiring
shorter hospital stays.
Large-volume paracentesis is also the preferred treatment for
massive ascites. Diuretics are sometimes used to prevent new fluid
accumulations, and the procedure may need to be repeated
periodically.
In cases of ascites that do not respond appropriately to the
treatments described above, a peritoneovenous shunt may be inserted.
This device is equipped with a one-way valve that allows fluid from
the peritoneal cavity to pass into the venous blood circulatory
system. From there the fluid is eliminated by the kidneys. In cases
of malignant ascites, there is a concern that the use of such a
shunt could enhance the spread of the cancer. This relatively small
risk must be balanced against the positive effect the shunt can have
on the individual's quality of life as well as against his or her
expected survival period.
