Ascites

Ascites is a collection of fluid which gathers around abdominal organs and gives children affected a swollen tummy. It can be caused by portal hypertension. It can be associated with oedema which is swelling in tissues in other areas of the body. Oedema is more likely to occur around the eyes and face and in the foot, ankles and leg.

Ascites can be caused by:

Less albumin (a protein) being made by the liver

Albumin helps to keep fluid within blood vessels. If the liver produces less albumin, its levels fall and fluid leaks out of blood vessels and collects in cavities and tissues in the body. When the fluid collects in the abdomen it is known as ascites.

The fluid can also leak into the space between the lungs and the chest wall which is known as pleural effusion.

Increased pressure within blood vessels

Portal hypertension raises the blood pressure in the veins and around abdominal organs which leads to fluid leaking into the abdomen.

Salt being retained in the body

This can contribute to the build-up of fluid in the tissues and cavities.

• protruding tummy. Signs of this can be the need for bigger clothes or nappies. Sometimes the belly button can be pushed outwards (umbilical hernia).
• shiny, tight skin over the swollen tummy
• prominent veins visible beneath the skin on the tummy
• quick weight gain which is not due to normal growth
• shortness of breath
• loss of appetite (eating less)

A diagnosis can be made by the doctor examining the child or by using an ultrasound scan.

Poor nutritional progress
The fluid in the abdomen can make children feel full very easily. Children may eat smaller portions and can vomit due to limited space in the abdomen. A dietician will be able to advise and support you. CLDF has a leaflet on nutrition with further information.

Infection
The fluid in the abdomen can become infected by bacteria. This is called spontaneous bacterial peritonitis.

Any fever with pain or tenderness over the abdomen with ascites should be reported to the medical team immediately. This is usually treated with intravenous antibiotics.

Restricted movement
The movement of small children and toddlers can be restricted due to their enlarged tummies so they may not develop as quickly as expected. A physiotherapist will be able to advise on exercises to encourage developmental progress.

Breathing difficulties
Ascites can sometimes make breathing difficult as there is less room for the lungs to expand. It’s important to inform the medical team if this is a problem. Sitting in a more upright position can help as well as using extra pillows when in bed.

There are different treatments available to try and deal with ascites, although these won’t cure it.

Medicines
A diuretic may be prescribed. This is a medication which helps the body to get rid of extra fluid and will lead to needing to urinate (wee) more often. A diuretic called spironolactone is commonly used.

Children taking diuretics have an increased risk of becoming dehydrated (not having enough fluid) if they have vomiting or diarrhoea. This should be reported to their doctor, as well as the fact that they are on diuretics and have liver disease.

Nutrition and diet
A dietitian may advise changes to a child’s diet. It’s important to ensure the diet has enough nutrients and energy to grow and to reduce salt. Too much salt can make ascites worse so it’s important not to add salt to food and to avoid salty foods such as crisps.

Fluids
In some cases a reduction in the amount of fluid being drunk may be advised. This must not be done without medical advice and a dietitian and doctor will advise if this is necessary.

Albumin replacement
If the albumin in the blood stream is very low it might be necessary to give a child albumin. This is done through a drip and it may need to be repeated on several occasions.

Drainage of excess fluid (ascitic tap)
A thin needle is passed into the cavity in the abdomen. This is then attached either to a drain or to a syringe. A local anaesthetic is used to numb the area where the needle will be placed. This procedure is done using an ultrasound scan for guidance.