Ascites

Epidemiology

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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

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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

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Treatment

Treatment of Cirrhotic Ascites

Loop Diuretics

  • Bumetanide (Bumex) (see Bumetanide, [[Bumetanide]])
  • Furosemide (Lasix) (see Furosemide, [[Furosemide]])

Other Diuretics

Therapeutic Paracentesis

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Transjugular Intrahepatic Portosystemic Shunt (TIPSS) (see Transjugular Intrahepatic Portosystemic Shunt, [[Transjugular Intrahepatic Portosystemic Shunt]])

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Peritoneovenous Denver Shunt

  • Indications
  • Contraindications

References

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