Diagnosis

Ascites

Etiology

Cause/Pathophysiology [wmo]

• Renal failure: Sodium and fluid retention

• Heart failure: Sodium and fluid retention

• Liver failure: Decreased albumin resulting in low plasma oncotic pressure

• Cirrhosis and portal hypertension: Elevated hydrostatic pressure

• Cancer: colorectal cancer, pancreatic cancer, gastric cancer, breast cancer, lymphoma, lung cancer, and ovarian cancer

Complication

• Spontaneous bacterial peritonitis

Epidemiology

Incidence per 100.000 [5dp][qki]

Approach

• Blood test: liver function test, creatinine, BNP

• Abdominal paracentesis

• Ultrasound abdomen

• CT abdomen

Treatment

1. Treat underlying cause of fluid retention [wmo]

2. Symptomatic treatment:

   • Sodium restriction (2000 mg/day)

   • Diuretics (spironolactone and furosemide)

   • Albumin

   • Terlipressin

   • Therapeutic paracentesis for symptom relief (albumin to prevent hypotension)

   • Transjugular intrahepatic portosystemic shunt

3. Treatable conditions: autoimmune hepatitis, chronic hepatitis B, hemochromatosis, Wilson disease, Infection (Tuberculosis, Chlamydia), Heart failure

4. Liver cirrhosis -> high-albumin-gradient ascites:

   • abstinence from alcohol

   • restricting dietary sodium

   • diuretics (spironolactone and furosemide)

   • Transjugular intrahepatic portosystemic shunt (TIPS)

5. Peritoneal carcinomatosis -> Low-albumin-gradient ascites:

   • outpatient therapeutic paracentesis for symptom relief

   • surgical debulking

   • chemotherapy

6. Pancreatic ascites and postoperative lymphatic -> usually resolve spontaneously

Differential diagnoses

Acute liver failure, Alcoholic liver disease, Biliary atresia, Breast cancer, Cardiomyopathy, Cirrhosis, Colorectal cancer, Gastric cancer, Heart failure, Hepatocellular carcinoma, Hypervolemia, Incisional hernia, Lung cancer, Lymphoma, Necrotizing enterocolitis, Nephrotic syndrome, Ovarian cancer, Pancreatic cancer, Portal hypertension, Primary biliary cirrhosis, Primary sclerosing cholangitis, Renal failure, Respiratory alkalosis, Tricuspid stenosis, Umbillical hernia, Viral hepatitis