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| {{Infobox medical condition
| | #REDIRECT [[Ascites]] |
| | name = Ascites
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| | image = Ascites2010.JPG
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| | caption = A patient with ascites
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| | field = [[Gastroenterology]]
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| | symptoms = Abdominal distension, discomfort
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| | complications = [[Spontaneous bacterial peritonitis]], [[hepatorenal syndrome]]
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| | causes = [[Cirrhosis]], [[heart failure]], [[cancer]]
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| | diagnosis = [[Physical examination]], [[ultrasound]], [[paracentesis]]
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| | treatment = [[Diuretics]], [[paracentesis]], [[TIPS]]
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| | prognosis = Variable, depending on underlying cause
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| | frequency = Common in cirrhosis
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| }}
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| '''Ascites''' is the accumulation of fluid in the [[peritoneal cavity]], causing abdominal swelling. It is most commonly associated with [[liver cirrhosis]], but can also result from other conditions such as [[heart failure]], [[cancer]], and [[tuberculosis]].
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| ==Pathophysiology==
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| Ascites occurs due to a combination of factors that lead to fluid retention and leakage into the peritoneal cavity. The primary mechanisms include: | |
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| * '''Portal hypertension''': Increased pressure in the [[portal venous system]] due to cirrhosis or other liver diseases leads to the transudation of fluid into the peritoneal cavity.
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| * '''Hypoalbuminemia''': Reduced levels of [[albumin]] in the blood decrease the oncotic pressure, allowing fluid to leak out of the blood vessels.
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| * '''Sodium and water retention''': Activation of the [[renin-angiotensin-aldosterone system]] and [[antidiuretic hormone]] secretion lead to increased sodium and water retention by the kidneys.
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| ==Causes==
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| The most common causes of ascites include:
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| * '''[[Cirrhosis]]''': Accounts for approximately 80% of ascites cases. The scarring of the liver tissue impairs blood flow and increases portal pressure.
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| * '''[[Heart failure]]''': Right-sided heart failure can lead to increased venous pressure and fluid accumulation.
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| * '''[[Malignancy]]''': Cancers, particularly [[ovarian cancer]], can cause malignant ascites due to peritoneal carcinomatosis.
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| * '''[[Tuberculosis]]''': Peritoneal tuberculosis can lead to exudative ascites.
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| ==Clinical Presentation==
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| Patients with ascites may present with:
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| * '''Abdominal distension''': Noticeable swelling of the abdomen due to fluid accumulation.
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| * '''Abdominal discomfort''': Pain or discomfort due to the stretching of the abdominal wall.
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| * '''Shortness of breath''': Large volumes of ascitic fluid can restrict diaphragmatic movement.
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| * '''Weight gain''': Rapid increase in weight due to fluid retention.
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| ==Diagnosis==
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| The diagnosis of ascites involves:
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| * '''[[Physical examination]]''': Detection of shifting dullness and fluid wave on abdominal examination.
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| * '''[[Ultrasound]]''': Imaging to confirm the presence of fluid and assess the liver and other abdominal organs.
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| * '''[[Paracentesis]]''': Aspiration of ascitic fluid for analysis, including cell count, albumin, and culture.
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| ==Management==
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| The management of ascites includes:
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| * '''Dietary sodium restriction''': Limiting sodium intake to reduce fluid retention.
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| * '''[[Diuretics]]''': Medications such as [[spironolactone]] and [[furosemide]] to promote diuresis.
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| * '''Therapeutic paracentesis''': Removal of large volumes of ascitic fluid to relieve symptoms.
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| * '''[[Transjugular intrahepatic portosystemic shunt]] (TIPS)''': A procedure to reduce portal hypertension in refractory cases.
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| ==Complications==
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| Complications of ascites can include:
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| * '''[[Spontaneous bacterial peritonitis]] (SBP)''': Infection of the ascitic fluid, requiring prompt antibiotic treatment.
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| * '''[[Hepatorenal syndrome]]''': A type of kidney failure associated with severe liver disease and ascites.
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| ==Prognosis==
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| The prognosis of ascites depends on the underlying cause. In cirrhosis, the development of ascites is a poor prognostic indicator and often signifies advanced liver disease.
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| ==See also==
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| * [[Cirrhosis]]
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| * [[Portal hypertension]]
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| * [[Peritoneal cavity]]
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| {{Gastroenterology}}
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| {{Liver diseases}}
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| [[Category:Medical conditions related to the liver]]
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| [[Category:Gastroenterology]]
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| [[Category:Symptoms and signs: Digestive system and abdomen]]
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