Abdominal swelling and heart failure

Fluid may build up between cells in the organs of the abdomen and affect organ size and function. Some people with heart failure may be severely bothered by abdominal bloating, while others may hardly notice it. The nature of the bloating depends on what is causing it. When the failing heart causes blood to back up into the abdomen, the excess fluid can cause a buildup of fluid (edema) in a number of places, including:

• Liver tissues. Your liver is in the upper right of your abdomen under the rib cage. Swelling of the liver can cause your abdomen to feel distended and can cause tenderness in the area of your liver. Severe fluid buildup in the liver may keep it from functioning properly. In extreme cases, fluid buildup in the liver can cause the skin to develop a yellow color, a condition known as jaundice. This can happen when the congestion and poor blood supply to the liver make the liver unable to metabolize bile, which causes the bile to build up in the bloodstream.
• Stomach tissues. Excess fluid can cause the walls of the stomach to swell. This swelling can decrease the space inside the stomach and can narrow the space where digested food travels from the stomach into the small intestine. As a result, you may feel full, or even nauseated or bloated, after eating a relatively small amount of food.
• Tissues of the small intestine. Like fluid buildup in the stomach, fluid buildup in the walls of the small intestine can cause you to feel full. In some people with heart failure, this can lead to malnutrition, not only because they eat less but because the intestine is not able to absorb nutrients as well as it normally does.
• Abdomen (ascites). Fluid can leak into the "open" space inside the abdomen called the peritoneal space, causing a condition that doctors call ascites. It is possible for several liters of fluid to leak into the peritoneal space, which can cause weight gain and abdominal bloating and also can cause vomiting or nausea. If you have ascites and your abdomen becomes tender or your develop a fever, you need to see a doctor, because the fluid may become infected. Although people with heart failure most commonly experience swelling in the legs, ankles, and abdomen, any part of your body can swell. If you are bed-bound, you may notice swelling in your lower back or scrotum. In very severe heart failure, your entire body can be swollen, a condition known as anasarca.