5-Minute Emergency Consult
Ascites
Ascites is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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
Etiology
- Parenchymal liver disease:
- Cirrhosis and alcoholic hepatitis:
- 80% of adult patients
- Fulminant hepatic failure
- Cirrhosis and alcoholic hepatitis:
- 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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Basics
Description
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
Etiology
- Parenchymal liver disease:
- Cirrhosis and alcoholic hepatitis:
- 80% of adult patients
- Fulminant hepatic failure
- Cirrhosis and alcoholic hepatitis:
- 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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Citation
Schaider, Jeffrey J., 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: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307084/all/Ascites. Accessed June 19, 2021.
Ascites. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th edition). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307084/all/Ascites
Ascites [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2021 June 19]. 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 - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
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 -
