Ascites

Description

• Pathologic accumulation of serous fluid in the peritoneal cavity
• Portal hypertension (>12 mm Hg) starts fluid retention
• Avid sodium retention state
• Retained sodium and water increases plasma volume
• Water excretion becomes impaired
• Increased release of antidiuretic hormone (ADH)
• Urinary sodium retention, increased total body sodium, and dilutional hyponatremia
• Degree of hyponatremia correlates with disease severity; prognostic factor
• Decreased plasma oncotic pressure from hypoalbuminemia
• Peritoneal irritation owing to infection, inflammation, or malignancy

Etiology

• Parenchymal liver disease:
  • Cirrhosis and alcoholic hepatitis:
    • 80% of adult patients
  • Fulminant hepatic failure
• Hepatic congestion:
  • CHF
  • Constrictive pericarditis
  • Veno-occlusive disease and Budd–Chiari syndrome
• Malignancies:
  • Peritoneal carcinomatosis
  • Hepatocellular carcinoma or metastatic disease
• Infections:
  • TB, fungal, or bacterial peritonitis
• Hypoalbuminemic states:
  • Nephrotic syndrome
  • Malnutrition; albumin <2.0 g/dL
• Other conditions:
  • Pancreatic ascites
  • Biliary ascites
  • Nephrogenous ascites
  • Ovarian tumors
  • Chylous ascites from lymphatic leak
  • Connective tissue disease
  • Myxedema
  • Granulomatous peritonitis

• Malignancy (Burkitt lymphoma, rhabdomyosarcoma)
• Nephrotic syndrome
• Malnutrition