Asc

Ascites
Ascites2010.JPG
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Abdominal distension, discomfort
Complications	Spontaneous bacterial peritonitis, hepatorenal syndrome
Onset	N/A
Duration	N/A
Types	N/A
Causes	Cirrhosis, heart failure, cancer
Risks	N/A
Diagnosis	Physical examination, ultrasound, paracentesis
Differential diagnosis	N/A
Prevention	N/A
Treatment	Diuretics, paracentesis, TIPS
Medication	N/A
Prognosis	Variable, depending on underlying cause
Frequency	Common in cirrhosis
Deaths	N/A

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.

Pathophysiology

Ascites occurs due to a combination of factors that lead to fluid retention and leakage into the peritoneal cavity. The primary mechanisms include:

• 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.
• Hypoalbuminemia: Reduced levels of albumin in the blood decrease the oncotic pressure, allowing fluid to leak out of the blood vessels.
• 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.

Causes

The most common causes of ascites include:

• Cirrhosis: Accounts for approximately 80% of ascites cases. The scarring of the liver tissue impairs blood flow and increases portal pressure.
• Heart failure: Right-sided heart failure can lead to increased venous pressure and fluid accumulation.
• Malignancy: Cancers, particularly ovarian cancer, can cause malignant ascites due to peritoneal carcinomatosis.
• Tuberculosis: Peritoneal tuberculosis can lead to exudative ascites.

Clinical Presentation

Patients with ascites may present with:

• Abdominal distension: Noticeable swelling of the abdomen due to fluid accumulation.
• Abdominal discomfort: Pain or discomfort due to the stretching of the abdominal wall.
• Shortness of breath: Large volumes of ascitic fluid can restrict diaphragmatic movement.
• Weight gain: Rapid increase in weight due to fluid retention.

Diagnosis

The diagnosis of ascites involves:

• Physical examination: Detection of shifting dullness and fluid wave on abdominal examination.
• Ultrasound: Imaging to confirm the presence of fluid and assess the liver and other abdominal organs.
• Paracentesis: Aspiration of ascitic fluid for analysis, including cell count, albumin, and culture.

Management

The management of ascites includes:

• Dietary sodium restriction: Limiting sodium intake to reduce fluid retention.
• Diuretics: Medications such as spironolactone and furosemide to promote diuresis.
• Therapeutic paracentesis: Removal of large volumes of ascitic fluid to relieve symptoms.
• Transjugular intrahepatic portosystemic shunt (TIPS): A procedure to reduce portal hypertension in refractory cases.

Complications

Complications of ascites can include:

• Spontaneous bacterial peritonitis (SBP): Infection of the ascitic fluid, requiring prompt antibiotic treatment.
• Hepatorenal syndrome: A type of kidney failure associated with severe liver disease and ascites.

Prognosis

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.

See also

• Cirrhosis
• Portal hypertension
• Peritoneal cavity