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Ascites is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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  • 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


  • 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

Pediatric Considerations
Most pediatric cases owing to:
  • Malignancy (Burkitt lymphoma, rhabdomyosarcoma)
  • Nephrotic syndrome
  • Malnutrition

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Rosen, Peter, et al., editors. "Ascites." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307084/all/Ascites.
Ascites. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307084/all/Ascites. Accessed April 23, 2019.
Ascites. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307084/all/Ascites
Ascites [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307084/all/Ascites.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ascites ID - 307084 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307084/all/Ascites PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -