Ascites
Ascites is a topic covered in the 5-Minute Clinical Consult.
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Basics
Description
- Accumulation of fluid in the peritoneal cavity; may occur in conditions that cause generalized edema
- Men generally have no fluid in peritoneal cavity; women may have up to 20 mL depending on menstrual phase.
Epidemiology
- Children: most commonly associated with nephrotic syndrome and malignancy
- Adults: cirrhosis (81%), cancer (10%), heart failure (3%), other (6%)
Incidence
~50–60% of cirrhotic patients develop ascites within 10 years (1).
Prevalence
10% of patients with cirrhosis have ascites.
Etiology and Pathophysiology
- Portal hypertension versus nonportal hypertension causes
- Cannot reliably establish/confirm etiology without paracentesis
- Serum-ascites albumin gradient (SAAG): (serum albumin level: ascites albumin level) helps to differentiate causes
- High portal pressure (SAAG ≥1.1)
- Cirrhosis
- Hepatitis (alcoholic, viral, autoimmune, medications)
- Acute liver failure
- Liver malignancy (primary or metastatic)
- Elevated right-sided filling pressures from heart failure or constrictive pericarditis
- Hepatic venous thrombosis (Budd-Chiari syndrome)
- Portal vein thrombosis
- Normal portal pressure (SAAG <1.1)
- Peritoneal carcinomatosis
- Tuberculosis
- Severe hypoalbuminemia (nephrotic syndrome; severe enteropathy with protein loss)
- Meigs syndrome (ovarian cancer)
- Lymphatic leak (chylous ascites)
- Pancreatitis
- Inflammatory (vasculitis, lupus serositis, sarcoidosis)
- Other infections (parasitic, fungal)
- Hemoperitoneum (trauma or ectopic pregnancy)
- Pathophysiology is best described for portal hypertensive (typically cirrhotic) ascites.
- Reduced renal and carotid perfusion activates systemic vasoconstrictors and antinatriuretic mechanisms. This stimulates the sympathetic nervous system and renin-angiotensin-aldosterone system to retain sodium and water.
- Most ascites is due to portal hypertension, with preferentially dilated splanchnic vasculature causing systemic hypotension.
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Citation
Stephens, Mark B., et al., editors. "Ascites." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116056/all/Ascites.
Ascites. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116056/all/Ascites. Accessed December 8, 2019.
Ascites. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116056/all/Ascites
Ascites [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 December 08]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116056/all/Ascites.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Ascites
ID - 116056
ED - Stephens,Mark B,
ED - Golding,Jeremy,
ED - Baldor,Robert A,
ED - Domino,Frank J,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116056/all/Ascites
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
ER -