Ascites
Epidemiology
Etiology
- Cirrhosis (see End-Stage Liver Disease, [[End-Stage Liver Disease]])
- Congestive Hepatopathy (Passive Hepatic Congestion) (see Congestive Hepatopathy, [[Congestive Hepatopathy]])
- Pancreatic Ascites (see Chronic Pancreatitis, [[Chronic Pancreatitis]]): high ascitic amylase and protein
- Intestinal Perforation: high ascitic amylase (due to leakage on pancreatic secretions from intestine into ascitic fluid)
- Endometriosis (see Endometriosis, [[Endometriosis]])
- Neoplasm with Peritoneal Carcinomatosis
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Physiology
Diagnosis
Paracentesis (see Paracentesis, [[Paracentesis]])
- Serum-Ascites Albumin Gradient (SAAG)
- SAAG = Serum Alb – Ascites Alb
- SAAG >1.1 = Portal hypertension-induced ascites (cirrhosis, massive hepatic mets)
- SAAG <1.1 = Non-portal hypertension-associated ascites (peritoneal carcinomatosis, TB, fungal, CMV, nephrotic syndrome, pancreatic ascites, protein-losing enteropathy)
- Hematocrit
- Cell Count and Differential: required
- Ascites Fluid Culture/Sensitivity
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Clinical Manifestations
Gastrointestinal Manifestations
- Abdominal Distention/Pain (see Abdominal Pain, [[Abdominal Pain]])
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Pulmonary Manifestations
- Acute Respiratory Failure (see Acute Hypoventilation, [[Acute Hypoventilation]]): due to abdominal distention with excessive work of breathing
- Dyspnea (see Dyspnea, [[Dyspnea]]): due to abdominal distention with high work of breathing
Other Manifestations
Treatment
Treatment of Cirrhotic Ascites
Loop Diuretics
- Bumetanide (Bumex) (see Bumetanide, [[Bumetanide]])
- Furosemide (Lasix) (see Furosemide, [[Furosemide]])
Other Diuretics
Therapeutic Paracentesis
Transjugular Intrahepatic Portosystemic Shunt (TIPSS) (see Transjugular Intrahepatic Portosystemic Shunt, [[Transjugular Intrahepatic Portosystemic Shunt]])
Peritoneovenous Denver Shunt
- Indications
- Contraindications
References
