Ascites

Basics

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
    • Acute hepatic failure:
      • Hepatic congestion
    • Heart failure
    • 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:
    • 5% of have 2 causes

Pediatric Considerations

Most pediatric cases owing to:

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

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