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{{CMG}} {{AE}} {{MUT}}
{{CMG}}; {{AE}} {{EG}}


==Overview==
==Overview==
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==Classification==
==Classification==
Ascites can be classified based on etiology:
<small>
* Portal hypertension
{{family tree/start}}
** Cirrhosis  
{{family tree| | | | | | | | | | | | | | B01 | | | | | | | | | |B01='''Ascites classification'''}}
** Alcoholic hepatitis  
{{family tree| | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | }}
** Acute liver failure  
{{family tree| | | | | | | C01 | | | | | | | | | | | C02 | | | |C01=Based on [[Etiology]]|C02=Based on [[SAAG]]}}
** Hepatic veno-occlusive disease
{{family tree| |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | |,|-|^|-|.| | }}
** Heart failure  
{{family tree| D01 | | D02 | | D03 | | D04 | | | D05 | | D06 |D01=[[Portal hypertension]]|D02=[[Hypoalbuminemia]]|D03=[[Peritoneal]] disease|D04=Other etiologies|D05=High ([[SAAG]] > 1.1 g/dL)|D06=Low ([[SAAG]] < 1.1 g/dL)}}
** Constrictive pericarditis  
{{family tree| |!| | | |!| | | |!| | | |!| | | | |!| | | |!| | }}
** Hemodialysis-associated ascites
{{family tree| boxstyle=text-align: left; | E01 | | E02 | | E03 | | E04 | | | E05 | | E06 |E01=• [[Cirrhosis]]<br>• [[Alcoholic hepatitis]]<br>• [[Acute liver failure]]<br>• [[Hepatic]] veno-occlusive disease<br>• [[Heart failure]]<br>• [[Constrictive pericarditis]]<br>• [[Hemodialysis]]-associated|E02=• [[Nephrotic syndrome]]<br>• [[Protein]]-losing [[enteropathy]]<br>• Severe [[malnutrition]]|E03=• [[Malignant]] ascites<br>• Infectious [[peritonitis]]<br>• [[Eosinophilic]] [[gastroenteritis]]<br>• Starch [[granulomatous peritonitis]]<br>• [[Peritoneal dialysis]]<br>• Multicystic [[mesothelioma]] ([[peritoneal inclusion cyst]])|E04=• [[Chylous ascites]]<br>• [[Pancreatic]] ascites<br>• [[Myxedema]]<br>• [[Hemoperitoneum]]<br>• [[Urologic]] injury|E05=• [[Cirrhosis]]<br>• [[Fulminant hepatic failure]]<br>• Veno-occlusive disease<br>• [[Hepatic vein obstruction]] (ie, [[Budd-Chiari syndrome]])<br>• [[Congestive heart failure]]<br>• [[Nephrotic syndrome]]<br>• [[Protein]]-losing [[enteropathy]]<br>• [[Malnutrition]]<br>• [[Myxedema]]<br>• [[Ovarian]] [[tumors]]<br>• [[Pancreatic]] ascites<br>• [[Biliary]] ascites<br>• [[Malignancy]]<br>• [[Trauma]]<br>• [[Portal hypertension]]|E06=• Primary [[peritoneal]] [[mesothelioma]]<br>• Secondary [[peritoneal]] [[carcinomatosis]]<br>• [[Tuberculous]] [[peritonitis]]<br>• [[Fungal]] and [[parasitic]] infections (eg, [[Candida]], [[Histoplasma capsulatum|Histoplasma]], [[Cryptococcus]], [[Schistosoma mansoni]], [[Strongyloides]], [[Entamoeba histolytica]])<br>• [[Sarcoidosis]]<br>• [[Foreign bodies]] (i.e., talc, cotton and wood fibers, [[starch]], [[barium]])<br>• [[Systemic lupus erythematosus]]<br>• [[Henoch-Schönlein purpura]]<br>• [[Eosinophilic]] [[gastroenteritis]]<br>• [[Whipple disease]]<br>• [[Endometriosis]]}}
* Hypoalbuminemia
{{family tree/end}}
** Nephrotic syndrome
</small>
** Protein-losing enteropathy
 
** Severe malnutrition
 
* Peritoneal disease
** Malignant ascites  
** Infectious peritonitis
** Eosinophilic gastroenteritis
** Starch granulomatous peritonitis
** Peritoneal dialysis  
** Multicystic mesothelioma (peritoneal inclusion cysts)  
* Other etiologies
** Chylous ascites  
** Pancreatic ascites  
** Myxedema  
** Hemoperitoneum  
** Urologic injury
Ascites is broadly classified as two types based on the [[Serum-ascites albumin gradient]] (SAAG):
Ascites is broadly classified as two types based on the [[Serum-ascites albumin gradient]] (SAAG):
* Transudate - SAAG > 1.1 g/dL (indicates the ascites is due to [[portal hypertension]]).
* Transudate - SAAG > 1.1 g/dL (indicates the ascites is due to [[portal hypertension]]).

Revision as of 16:40, 8 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Classification

 
 
 
 
 
 
 
 
 
 
 
 
 
Ascites classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on Etiology
 
 
 
 
 
 
 
 
 
 
Based on SAAG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Portal hypertension
 
Hypoalbuminemia
 
Peritoneal disease
 
Other etiologies
 
 
High (SAAG > 1.1 g/dL)
 
Low (SAAG < 1.1 g/dL)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cirrhosis
Alcoholic hepatitis
Acute liver failure
Hepatic veno-occlusive disease
Heart failure
Constrictive pericarditis
Hemodialysis-associated
 
Nephrotic syndrome
Protein-losing enteropathy
• Severe malnutrition
 
Malignant ascites
• Infectious peritonitis
Eosinophilic gastroenteritis
• Starch granulomatous peritonitis
Peritoneal dialysis
• Multicystic mesothelioma (peritoneal inclusion cyst)
 
Chylous ascites
Pancreatic ascites
Myxedema
Hemoperitoneum
Urologic injury
 
 
Cirrhosis
Fulminant hepatic failure
• Veno-occlusive disease
Hepatic vein obstruction (ie, Budd-Chiari syndrome)
Congestive heart failure
Nephrotic syndrome
Protein-losing enteropathy
Malnutrition
Myxedema
Ovarian tumors
Pancreatic ascites
Biliary ascites
Malignancy
Trauma
Portal hypertension
 
• Primary peritoneal mesothelioma
• Secondary peritoneal carcinomatosis
Tuberculous peritonitis
Fungal and parasitic infections (eg, Candida, Histoplasma, Cryptococcus, Schistosoma mansoni, Strongyloides, Entamoeba histolytica)
Sarcoidosis
Foreign bodies (i.e., talc, cotton and wood fibers, starch, barium)
Systemic lupus erythematosus
Henoch-Schönlein purpura
Eosinophilic gastroenteritis
Whipple disease
Endometriosis


Ascites is broadly classified as two types based on the Serum-ascites albumin gradient (SAAG):

  • Transudate - SAAG > 1.1 g/dL (indicates the ascites is due to portal hypertension).
  • Exudate - SAAG < 1.1 g/dL (indicates the ascites is due to non-portal hypertension etiology).

References

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