Causes of ascites:
Transudate (< 30 g/L)
- cirrhosis, portal hypertension – usually late
- congestive cardiac failure / constrictive pericarditis
- nephrotic syndrome – hypoalbuminaemia
- Budd-Chiari syndrome – hepatic vein thrombosis, inferior vena caval thrombosis
- Meigs syndrome
Exudate (> 30 g/L)
- malignant disease – bowel, gynaecological
- infection – tuberculous, pyogenic
- pancreatitis
- myxoedema
- lymphatic obstruction – chylous ascites
Management of ascites:
- Unless the diagnosis is obvious, confirm the presence of ascites using ultrasonography or CT.
- Ascitic fluid can become infected (spontaneous bacterial peritonitis), often with pain and fever. Diagnosis of infection involves analysis and culture of ascitic fluid. Infection is treated with antibiotics.
- If ascites is newly diagnosed, its cause is unknown, or spontaneous bacterial peritonitis is suspected, do paracentesis and test ascitic fluid.
- Recommend dietary sodium restriction; if insufficiently effective, consider use of diuretics and therapeutic paracentesis.
- Promptly refer patients with refractory ascites for consideration of liver transplantation.¹
- i.e. the development of ascites is associated with a poor prognosis, with a mortality of 15% at one-year and 44% at five-year follow-up, respectively²
References
- Ascites – Hepatic and Biliary Disorders – MSD Manual Professional Edition (msdmanuals.com)
- Biecker E. Diagnosis and therapy of ascites in liver cirrhosis. World J Gastroenterol. 2011;17(10):1237-1248. doi:10.3748/wjg.v17.i10.1237.
