7/27/2019 Gokul 123123

1/4

Ascites

Ascites is term for an accumulation of fluid in the peritoneal cavity(space between the tissues lining the

abdomen and abdominal organs). The condition is also known as peritoneal cavity fluid, peritoneal fluid

excess, hydroperitoneum or more archaically as abdominal dropsy

Causes

TheSerum-ascites albumin gradient(SAAG) is probably a better discriminant than older measures

(transudate versus exudate) for the causes of ascites

Causes of high SAAG ("transudate") are:[3]

Cirrhosis - 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%)

The two most important factors in the production of ascites due to chronic liver disease are:

Low levels of albumin in the blood that cause a change in the pressure necessary toprevent fluid exchange (osmotic pressure). This change in pressure allows fluid to seep

out of the blood vessels.

An increase in the pressure within the branches of the portal vein that run through liver(portal hypertension). Portal hypertension is caused by the scarring that occurs in

cirrhosis. Blood that cannot flow through the liver because of the increased pressure leaks

into the abdomen and causes ascites.

Heart failure - 3%

Hepatic Venous occlusion: Budd-Chiari syndrome orveno-occlusive disease

Constrictive pericarditis

Kwashiorkor

Causes of low SAAG ("exudate") are:

Cancer(primary peritoneal carcinomatosis and metastasis) - 10%

Infection: Tuberculosis - 2% orSpontaneous bacterial peritonitis

Pancreatitis - 1%

Serositis

Nephrotic syndrome or Protein losing enteropathy

http://en.wikipedia.org/wiki/Peritoneal_cavityhttp://en.wikipedia.org/wiki/Peritoneal_cavityhttp://en.wikipedia.org/wiki/Serum-ascites_albumin_gradienthttp://en.wikipedia.org/wiki/Serum-ascites_albumin_gradienthttp://en.wikipedia.org/wiki/Serum-ascites_albumin_gradienthttp://en.wikipedia.org/wiki/Serum-ascities_albumin_gradienthttp://en.wikipedia.org/wiki/Ascites#cite_note-OTM-2http://en.wikipedia.org/wiki/Ascites#cite_note-OTM-2http://en.wikipedia.org/wiki/Ascites#cite_note-OTM-2http://en.wikipedia.org/wiki/Cirrhosishttp://medical-dictionary.thefreedictionary.com/Hypertensionhttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Budd-Chiari_syndromehttp://en.wikipedia.org/wiki/Veno-occlusive_diseasehttp://en.wikipedia.org/wiki/Constrictive_pericarditishttp://en.wikipedia.org/wiki/Kwashiorkorhttp://en.wikipedia.org/wiki/Serum-ascities_albumin_gradienthttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Spontaneous_bacterial_peritonitishttp://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Serositishttp://en.wikipedia.org/wiki/Nephrotic_syndromehttp://en.wikipedia.org/wiki/Nephrotic_syndromehttp://en.wikipedia.org/wiki/Serositishttp://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Spontaneous_bacterial_peritonitishttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Serum-ascities_albumin_gradienthttp://en.wikipedia.org/wiki/Kwashiorkorhttp://en.wikipedia.org/wiki/Constrictive_pericarditishttp://en.wikipedia.org/wiki/Veno-occlusive_diseasehttp://en.wikipedia.org/wiki/Budd-Chiari_syndromehttp://en.wikipedia.org/wiki/Heart_failurehttp://medical-dictionary.thefreedictionary.com/Hypertensionhttp://en.wikipedia.org/wiki/Cirrhosishttp://en.wikipedia.org/wiki/Ascites#cite_note-OTM-2http://en.wikipedia.org/wiki/Serum-ascities_albumin_gradienthttp://en.wikipedia.org/wiki/Serum-ascites_albumin_gradienthttp://en.wikipedia.org/wiki/Peritoneal_cavity

7/27/2019 Gokul 123123

2/4

Hereditary angioedema[5]

Ovarian cancer, endometrial cancer

Pancreatitis

Pancreatic cancer

Protein-losing enteropathy

Kidney dialysis may also be associated with ascites

Other Rare causes:

Meigs syndrome

Vasculitis

Hypothyroidism

Renal Dialysis

Peritoneum Mesothelioma

Types

Types of ascites

Cirrhosis, which is responsible for 80% of all instances of ascities , triggers a series of disease-

producing changes that weaken the kidney's ability to excrete sodium in the urine.

Pancreatic ascites develops when a cyst that has thick, fibrous walls (pseudocyst) bursts and

permits pancreatic juices to enter the abdominal cavity.

Chylous ascites has a milky appearance caused by lymph that has leaked into the abdominal

cavity..

Cancer causes 10% of all instances of ascites . It is most commonly a consequence of disease

that originates in the peritoneum (peritoneal carcinomatosis) or of cancer that spreads

(metastasizes) from another part of the body.

Endocrine and renal ascites are rare disorders.

Endocrine ascites, sometimes a symptom of an endocrine system disorder, also affects women

who are taking fertility drugs.

Renal ascites develops when blood levels of albumin dip below normal. Albumin is the major

protein in blood plasma. It functions to keep fluid inside the blood vessels

.

http://en.wikipedia.org/wiki/Angioedemahttp://en.wikipedia.org/wiki/Angioedemahttp://en.wikipedia.org/wiki/Angioedemahttp://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000889/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001144/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001144/http://en.wikipedia.org/wiki/Meigs_syndromehttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Hypothyroidismhttp://medical-dictionary.thefreedictionary.com/Cirrhosishttp://medical-dictionary.thefreedictionary.com/Cirrhosishttp://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Meigs_syndromehttp://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001144/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000889/http://en.wikipedia.org/wiki/Angioedemahttp://en.wikipedia.org/wiki/Angioedema

7/27/2019 Gokul 123123

3/4

Signs and Symptoms

Mild ascites is hard to notice, but severe ascites leads to abdominal distension.

Patients with ascites generally will complain of progressive abdominal heaviness and pressure as

well as shortness of breath due to mechanical impingement on the diaphragm.

in portal hypertension (perhaps due to cirrhosis or fibrosis of the liver) patients may also complain

of leg swelling, bruising, gynecomastia, hematemesis, or mental changes due to encephalopathy.

Those with ascites due tocancer(peritoneal carcinomatosis) may complain of chronic fatigue or

weight loss

Those with ascites due to heart failure may also complain of shortness of breath as well as

wheezing and exercise intolerance.\

A person with ascites usually has severe liver disease. Ascites due to liver disease is

caused by high pressure in the blood vessels of the liver (portal hypertension) andlow albumin levels.

Differential Diagnosis

Chrinic liver disease

Right sided heart failure

Nephrotic syndrome

Hypo protienemia

Portal hyoer tension

Examination

Ascites is detected on physical examination of the abdomen by visible bulging of the flanks in the

reclining patient ("flank bulging"),

"shifting dullness" (difference in percussion note in the flanks that shifts when the patient is turned on theside)

In massive ascites with a "fluid thrill" or"fluid wave" (tapping or pushing on one side will generate a wave-

like effect through the fluid that can be felt in the opposite side of the abdomen).

http://en.wikipedia.org/wiki/Abdominal_distensionhttp://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Diaphragm_(anatomy)http://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Gynecomastiahttp://en.wikipedia.org/wiki/Hematemesishttp://en.wikipedia.org/wiki/Encephalopathyhttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Heart_failurehttp://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000205/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003480/http://en.wikipedia.org/wiki/Physical_examinationhttp://en.wikipedia.org/wiki/Bulging_flankshttp://en.wikipedia.org/wiki/Shifting_dullnesshttp://en.wikipedia.org/wiki/Fluid_wave_testhttp://en.wikipedia.org/wiki/Fluid_wave_testhttp://en.wikipedia.org/wiki/Shifting_dullnesshttp://en.wikipedia.org/wiki/Bulging_flankshttp://en.wikipedia.org/wiki/Physical_examinationhttp://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003480/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000205/http://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Encephalopathyhttp://en.wikipedia.org/wiki/Hematemesishttp://en.wikipedia.org/wiki/Gynecomastiahttp://en.wikipedia.org/wiki/Portal_hypertensionhttp://en.wikipedia.org/wiki/Diaphragm_(anatomy)http://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Abdominal_distension

7/27/2019 Gokul 123123

4/4

Investigations

24-hour urine collection

Creatinine and electrolytes

Kidney function tests

Liver enzyme, bilirubin, coagulation, and serum protein tests

Urinalysis

Paracentesis orabdominal tap may be performed. This procedure involves using a thin needle topull fluid from the abdomen. The fluid is tested in various ways to determine the cause of ascites.

http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003622/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003479/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003896/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003896/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003479/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003622/