Ascites
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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
- 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
- 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
- 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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