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| [[File:Siren.gif|link=Ascites resident survival guide|41x41px]]|| <br> || <br>
| [[Ascites resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Infobox_Disease
{{Infobox_Disease
  | Name          = Ascites
  | Name          = Ascites
  | Image          = Ascites.png
  | Image          = Ascites.png
  | Caption        =  
  | Caption        =  
| DiseasesDB    = 943
| ICD10          = {{ICD10|R|18||r|10}}
| ICD9          = {{ICD9|789.5}}
| ICDO          =
| OMIM          =
| MedlinePlus    =
| eMedicineSubj  = ped
| eMedicineTopic = 2927
| eMedicine_mult = {{eMedicine2|med|173}}
| MeshID        =
}}
}}
{{SI}}
{{Ascites}}
{{CMG}}


{{editor help}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


==Overview==
'''For the approach to a patient with ascites, click [[Approach to a patient with ascites|here]].'''


In [[medicine]] ([[gastroenterology]]), '''ascites''' (also known as '''peritoneal cavity fluid''', '''peritoneal fluid excess''', '''hydroperitoneum''' or more archaically as '''abdominal dropsy''') is an accumulation of fluid in the [[peritoneal cavity]]. Although most commonly due to [[cirrhosis]] and severe [[liver disease]], its presence can portend other significant medical problems. Diagnosis of the cause is usually with [[blood test]]s, an [[medical ultrasonography|ultrasound scan]] of the abdomen and direct removal of the fluid by needle or [[paracentesis]] (which may also be therapeutic). Treatment may be with medication ([[diuretic]]s), paracentesis or other treatments directed at the cause.
{{CMG}}; {{AE}} {{EG}}


==Signs and symptoms==
{{SK}} Peritoneal cavity fluid, Peritoneal fluid excess, Hydroperitoneum, Abdominal dropsy, Excess peritoneal fluid.
Mild ascites is hard to notice, but severe ascites leads to [[abdominal distension]]. Patients with ascites generally will complain of progressive abdominal heaviness and pressure as well as [[shortness of breath]] due to mechanical impingement on the [[diaphragm (anatomy)|diaphragm]].  


Ascites is detected on [[physical examination]] of the abdomen by visible [[Bulging flanks|bulging of the flanks]] in the reclining patient ("flank bulging"), "[[shifting dullness]]" (difference in percussion note in the flanks that shifts when the patient is turned on the side) or in massive ascites with a "fluid thrill" or "[[Fluid wave test|fluid wave]]" (tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen).
==[[Ascites overview|Overview]]==


Other signs of ascites may be present due to its underlying etiology. For instance, in [[portal hypertension]] (perhaps due to cirrhosis or fibrosis of the liver) patients may also complain of leg swelling, bruising, [[gynecomastia]], [[hematemesis]], or mental changes due to [[encephalopathy]]. Those with ascites due to [[cancer]] (peritoneal carcinomatosis) may complain of chronic fatigue or weight loss. Those with ascites due to [[heart failure]] may also complain of shortness of breath as well as wheezing and exercise intolerance.
==[[Ascites historical perspective|Historical Perspective]]==


==Classification==
==[[Ascites classification|Classification]]==
Ascites exists in three grades:<ref>Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, Angeli P, Porayko M, Moreau R, Garcia-Tsao G, Jimenez W, Planas R, Arroyo V. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. ''Hepatology'' 2003;38:258-66. PMID 12830009.</ref>
* Grade 1: mild, only visible on ultrasound
* Grade 2: detectable with flank bulging and shifting dullness
* Grade 3: directly visible, confirmed with fluid thrill


==Diagnosis==
==[[Ascites pathophysiology|Pathophysiology]]==
Routine [[complete blood count]] (CBC), basic metabolic profile, [[liver enzymes]], and [[coagulation]] should be performed.  Most experts recommend a diagnostic [[paracentesis]] be performed if the ascites is new or if the patient with ascites is being admitted to the hospital. The fluid is then reviewed for its gross appearance, protein level, [[serum albumin|albumin]], and cell counts (red and white). Additional tests will be performed if indicated such as [[Gram stain]] and [[cytology]].<ref name=OTM>Warrell DA, Cox TN, Firth JD, Benz ED. ''Oxford textbook of medicine''. Oxford: Oxford University Press, 2003. ISBN 0-19-262922-0.</ref>
 
The ''[[Serum-ascites albumin gradient]]'' (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites.<ref>Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. ''Ann Intern Med'' 1992;117:215-20. PMID 1616215.</ref> A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive etiology.
 
[[Medical ultrasonography|Ultrasound]] investigation is often performed prior to attempts to remove fluid from the abdomen. This may reveal the size and shape of the abdominal organs, and Doppler studies may show the direction of flow in the portal vein, as well as detecting [[Budd-Chiari syndrome]] and [[portal vein thrombosis]]. Additionally, the sonographer can make an estimation of the amount of ascitic fluid, and difficult-to-drain ascites may be drained under ultrasound guidance. Abdominal [[CT scan]] is a more accurate alternate to reveal abdominal organ structure and morphology.


===Fetal Ascites===
==[[Ascites causes|Causes]]==
[[Ascites causes#Common causes|Common Causes]]  | [[Ascites causes#System based|System based]] | [[Ascites causes#Alphabetical order|Alphabetical order]]


Differential diagnosis of fetal ascites.
==[[Ascites differential diagnosis|Differentiating Ascites from other Conditions]]==


*[[Urinary ascites]]
==[[Ascites epidemiology and demographics|Epidemiology and Demographics]]==
*Bowel rupture (i.e. [[meconium peritonitis]])
*[[ovarian cyst|Ruptured ovarian cyst]]
*[[Hydrops]]
*[[Pseudoascites]]
*[[Infection]]


==Causes==
==[[Ascites risk factors|Risk Factors]]==
 
===Two broad classifications of ascites:===
Causes of high [[Serum-ascities albumin gradient|SAAG]] ("transudate") are:<ref name=OTM/>
* [[Cirrhosis]] - 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%)
* [[Heart failure]] - 3%
* [[Budd-Chiari syndrome]] or [[veno-occlusive disease]]
* [[Constrictive pericarditis]]
 
Causes of low [[Serum-ascities albumin gradient|SAAG]] ("exudate") are:
* [[Cancer]] (primary peritoneal carcinomatosis and metastasis) - 10%
* [[Tuberculosis]] - 2%
* [[Pancreatitis]] - 1%
* [[Serositis]]
* [[Nephrotic syndrome]]
 
===Complete Differential Diagnosis of Ascites (alphabetical):===
* [[1-alkylglycerophosphocholine O-acyltransferase]]
* [[Abdominal mass]]
* [[Acute liver failure]]
* [[Acute pancreatitis]]
* [[AIDS]]
* [[Alcoholic hepatitis]]
* [[Alcoholic liver disease]]
* [[Alveolar hydatid disease]]
* [[Amyloidosis]]
* [[Angioimmunoblastic T-cell lymphoma]]
* [[Arterioportal shunt]]
* [[Arteriovenous fistula]]
* [[Ascariasis]]
* [[Atenolol]]
* [[Bacterial infection]]
* [[Bacterial peritonitis]]
* [[Banti's syndrome]]
* [[Biliary fistula]]
* [[Bladder cancer]]
* [[Bland-White-Garland Syndrome]]
* [[Budd-Chiari syndrome]]
* [[Cancer]]
* [[Carcinoid tumours and carcinoid syndrome]]
* [[Cardiac amyloidosis]]
* [[Cardiac failure, right sided]]
* [[Catumaxomab]]
* [[Central obesity]]
* [[Ceratomyxa shasta]]
* [[Chilaiditi syndrome]]
* [[Cholangiocarcinoma]]
* [[Cholesterol pericarditis]]
* [[Chronic hepatitis]]
* [[Chylous ascites]]
* [[Cirrhosis]]
* [[Clostridium difficile]]
* [[Colorectal cancer]]
* [[Congestive Heart Failure]]
* [[Constipation]]
* [[Constrictive pericarditis]]
* [[Continuous ambulatory peritoneal dialysis]]
* [[Cryptococcus]]
* [[D-Bifunctional Protein Deficiency]]
* [[Dengue fever]]
* [[Desmoplastic small round cell tumor]]
* [[Diaphragmatic Elevation]]
* [[Diseases of the Pericardium]]
* [[Drug]]
* [[Endometriosis]]
* [[Endoscopic retrograde cholangiopancreatography]]
* [[Enterobiasis]]
* [[Eosinophilic gastroenteritis]]
* [[Eosinophilic peritonitis]]
* [[Esophageal cancer]]
* [[Ethanolamine kinase]]
* [[Extramedullary haemopoiesis]]
* [[Exudative enteropathy]]
* [[Familial Mediterranean Fever]]
* [[Fasciolopsiasis]]
* [[Fasciolosis]]
* [[Fatty liver]]
* [[Fermented wheat germ extract]]
* [[Fibrinogen]]
* [[Filariasis]]
* [[Fitz-Hugh Curtis syndrome]]
* [[Genital schistosomiasis]]
* [[Haemochromatosis]]
* [[Haemolytic disease of the newborn]]
* [[Heart failure]]
* [[Hemochromatosis]]
* [[Henoch-Schonlein Purpura]]
* [[Hepatic encephalopathy]]
* [[Hepatic failure]]
* [[Hepatic vein thrombosis]]
* [[Hepatitis]]
* [[Hepatitis C]]
* [[Hepato-biliary diseases]]
* [[Hepatorenal syndrome]]
* [[Hereditary lymphangiectasia]]
* [[Hereditary stomatocytosis]]
* [[Hernia]]
* [[Histoplasmosis]]
* [[Hookworm]]
* [[Hydrops fetalis]]
* [[Hypervolemia]]
* [[Hypoalbuminemia]]
* [[Hyponatremia]]
* [[Hypothyroidism]]
* [[Idiopathic]]
* [[Increased sodium reaborption in cirrhosis through secondary hypoaldosteronism]]
* [[Inosine kinase]]
* [[Intestinal lymphatic blockage]]
* [[Krukenberg tumor]]
* [[Kwashiorkor]]
* [[Leg Swelling]]
* [[Liver cancer, primary]]
* [[Liver metastases]]
* [[Ménétrier's disease]]
* [[Malaria (malignant tertian)]]
* [[Malignancy]]
* [[Malnutrition]]
* [[Meigs' syndrome]]
* [[Mesenteric vein thrombosis]]
* [[Mesothelioma]]
* [[Methotrexate Injection (patient information)]]
* [[Mirror syndrome]]
* [[Mucosal diseases with increased protein exudation]]
* [[Mycobacterial infection]]
* [[Myeloproliferative diseases]]
* [[N-acetyllactosaminide 3-alpha-galactosyltransferase]]
* [[N-acetyllactosaminide beta-1,3-N-acetylglucosaminyltransferase]]
* [[N-acetyllactosaminide beta-1,6-N-acetylglucosaminyl-transferase]]
* [[Neoplastic]]
* [[Nephrotic syndrome]]
* [[Noni]]
* [[Nutmeg liver]]
* [[Obesity hypoventilation syndrome]]
* [[Obstruction of the inferior vena cava]]
* [[Oesophageal cancer]]
* [[Oprelvekin]]
* [[Ovarian cancer]]
* [[Ovarian disease]]
* [[Ovarian hyperstimulation syndrome]]
* [[Pancreatic cancer]]
* [[Pancreatic disease]]
* [[Pancreatic fistula]]
* [[Pancreatitis with irritation of the peritoneum]]
* [[Pelvic Masses]]
* [[Pemetrexed injection (patient information)]]
* [[Pericardial constriction]]
* [[Peritoneal lymphangiectasis]]
* [[Peritoneal vasculitis]]
* [[Peritonitis]]
* [[POEMS syndrome]]
* [[Polycystic liver]]
* [[Polypeptide N-acetylgalactosaminyltransferase]]
* [[Portal hypertension]]
* [[Portal vein occlusion]]
* [[Poteinuria]]
* [[Primary biliary cirrhosis]]
* [[Protein A]]
* [[Protein L]]
* [[Protein losing enteropathy]]
* [[Proteinuria]]
* [[Pseudo-Meigs syndrome]]
* [[Pseudomonas]]
* [[Pseudomonas plecoglossicida]]
* [[Pseudomyxoma peritonei]]
* [[Puddle sign]]
* [[Pulmonary hypertension]]
* [[Pulmonic Regurgitation]]
* [[Right ventricular failure]]
* [[Ruptured dermoid cyst]]
* [[Sarcoidosis]]
* [[Schistosoma mansoni]]
* [[Schistosomiasis]]
* [[Shock]]
* [[Short rib-polydactyly syndrome type 4]]
* [[Splenic vein thrombosis]]
* [[Spontaneous bacterial peritonitis]]
* [[Starch peritonitis]]
* [[Stomach cancer]]
* [[Strongyloidiasis]]
* [[Surgery]]
* [[Systemic Lupus Erythematosus]]
* [[Thrombosis]]
* [[Transjugular intrahepatic portosystemic shunt]]
* [[Trauma]]
* [[Tricuspid insufficiency]]
* [[Trypanosoma cruzi]]
* [[Tuberculosis]]
* [[Tumor]]
* [[Turner's syndrome]]
* [[Umbilical hernia]]
* [[Uremia]]
* [[Uridine kinase]]
* [[Uridine phosphorylase]]
* [[Vasculitis]]
* [[Veno-occlusive disease]]
* [[Vitamin A overdose]]
* [[Weight Gain]]
* [[Whipple's disease]]
* [[Wilson's Disease]]


==[[Ascites screening|Screening]]==


==[[Ascites natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==Diagnosis==
==Diagnosis==


Images shown below are courtesy of RadsWiki
[[Ascites history and symptoms|History and Symptoms]] | [[ Ascites physical examination|Physical Examination]] | [[Ascites laboratory findings|Laboratory Findings]] | [[Ascites Paracentesis|Paracentesis]] | [[Ascites electrocardiogram|Electrocardiogram]] | [[Ascites chest x ray|Chest X Ray]] | [[Ascites CT|CT Scan]] | [[Ascites MRI|MRI]] | [[Ascites ultrasound|Ultrasound]] | [[Ascites other imaging findings|Other Imaging Findings]] | [[Ascites other diagnostic studies|Other Diagnostic Studies]]
 
===Large amount of peritoneal fluid ([[ascites]]) in patient with peritoneal carcinomatosis===
 
<gallery>
Image:Ascites-001.jpg
Image:Ascites-002.jpg
</gallery>
 
 
===Large amount of peritoneal fluid ([[ascites]]) in a patient with [[cholangiocarcinoma]]===
 
<gallery>
Image:Ascites 201.jpg
Image:Ascites 202.jpg
Image:Ascites 203.jpg
</gallery>
 
===Gross Images===
 
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<div align="left">
<gallery heights="175" widths="175">
Image:Ascites.png|Ascites in a patient with cirrhotic liver disease. Dilated abdominal veins are visible
Image:Ascites 1.jpg|[[Ascites]], the same patient, lateral view.
</gallery>
</div>
 
<div align="left">
<gallery heights="175" widths="175">
Image:Ascites Child.jpg|A 2 month old child with [[ascites]]. [[Ascites]] is a common form of [[tuberculosis]] in higher incidence areas.
Image:Ascites. Postmortem findings.jpg|Ascites: Postmortem findings
</gallery>
</div>
 
 
Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California
 
<div align="left">
<gallery heights="175" widths="175">
Image:Abdomen ascites.jpg|Ascites: Abdomen symetrically distended secondary to fluid buildup in    peritoneal cavity. Note bulging flanks as fluid distributes to most dependent areas of abdomen. Skin is also yellowed due to hyperbilirubinemia
Image:Abdomen ascites2.jpg|Ascites with Shifting Dullness: Ascitic fluid will flow to the most    dependent portions of the abdomen. The air-filled intestines will float on top of this liquid. The technique of    shifting dullness makes use of this relationship in order to detect the presence    of ascitic fluid.
</gallery>
</div>
 
 
<div align="left">
<gallery heights="175" widths="175">
Image:Abdomen ascites4.jpg|Ascites: Lateral view of abdomen tensely distended due to ascites.
Image:Abdomen ascites5.jpg|Ascites 
</gallery>
</div>


==Treatment==
==Treatment==
[[Ascites medical therapy|Medical Therapy]] | [[Ascites surgery |Surgery]] | [[Ascites primary prevention|Primary Prevention]] | [[Ascites secondary prevention|Secondary Prevention]] | [[Ascites cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ascites future or investigational therapies|Future or Investigational Therapies]]


Ascites is generally treated simultaneously while an underlying etiology is sought in order to prevent complications, to relieve symptoms and to prevent further progression. In patients with mild ascites, therapy is usually as an outpatient. The goal is weight loss of no more than 1.0 kg/day for patients with both ascites and [[peripheral edema]] and no more than 0.5 kg/day for patients with ascites alone.<ref name="pmid4910836">{{cite journal |author=Shear L, Ching S, Gabuzda GJ |title=Compartmentalization of ascites and edema in patients with hepatic cirrhosis |journal=N. Engl. J. Med. |volume=282 |issue=25 |pages=1391-6 |year=1970 |pmid=4910836 |doi=}}</ref> In those with severe ascites causing a tense abdomen, hospitalization is generally necessary for paracentesis.<ref name="pmid3297907">{{cite journal |author=Ginés P, Arroyo V, Quintero E, ''et al'' |title=Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study |journal=Gastroenterology |volume=93 |issue=2 |pages=234-41 |year=1987 |pmid=3297907 |doi=}}</ref><ref name="pmid3655306">{{cite journal |author=Salerno F, Badalamenti S, Incerti P, ''et al'' |title=Repeated paracentesis and i.v. albumin infusion to treat 'tense' ascites in cirrhotic patients. A safe alternative therapy |journal=J. Hepatol. |volume=5 |issue=1 |pages=102-8 |year=1987 |pmid=3655306 |doi=}}</ref>
==Case Studies==
 
===High SAAG===
====Salt restriction====
Salt restriction is the initial treatment, which allows [[diuresis]] (production of urine) since the patient now has more fluid than salt concentration. Salt restriction is effective in about 15% of patients.<ref name="pmid1860680">{{cite journal |author=Gatta A, Angeli P, Caregaro L, Menon F, Sacerdoti D, Merkel C |title=A pathophysiological interpretation of unresponsiveness to spironolactone in a stepped-care approach to the diuretic treatment of ascites in nonazotemic cirrhotic patients |journal=Hepatology |volume=14 |issue=2 |pages=231-6 |year=1991 |pmid=1860680 |doi=}}</ref>
====Diuretics====
Since salt restriction is the basic concept in treatment, and [[aldosterone]] is one of the hormones that acts to increase salt retention, a medication that counteracts aldosterone should be sought. [[Spironolactone]] (or other distal-tubule diuretics such as [[triamterene]] or [[amiloride]]) is the drug of choice since they block the aldosterone receptor in the collecting tubule. This choice has been confirmed in a [[randomized controlled trial]].<ref name="pmid7035545">{{cite journal |author=Fogel MR, Sawhney VK, Neal EA, Miller RG, Knauer CM, Gregory PB |title=Diuresis in the ascitic patient: a randomized controlled trial of three regimens |journal=J. Clin. Gastroenterol. |volume=3 Suppl 1 |issue= |pages=73-80 |year=1981 |pmid=7035545 |doi=}}</ref> Diuretics for ascites should be dosed once per day.<ref name="pmid8277955">{{cite journal |author=Runyon BA |title=Care of patients with ascites |journal=N. Engl. J. Med. |volume=330 |issue=5 |pages=337-42 |year=1994 |pmid=8277955 |doi=}}</ref> Generally, the starting dose is oral spironolactone 100 mg/day (max 400 mg/day).
40% of patients will respond to spironolactone.<ref name="pmid1860680"/> For nonresponders, a [[loop diuretic]] may also be added and generally, [[furosemide]] is added at a dose of 40 mg/day (max 160 mg/day), or alternatively ([[bumetanide]] or [[torasemide]]). The ratio of 100:40 reduces risks of potassium imbalance.<ref name="pmid8277955"/> Serum [[potassium]] level and renal function should be monitored closely while on these medications.<ref name="pmid15084697">{{cite journal |author=Ginès P, Cárdenas A, Arroyo V, Rodés J |title=Management of cirrhosis and ascites |journal=N. Engl. J. Med. |volume=350 |issue=16 |pages=1646-54 |year=2004 |pmid=15084697 |doi=10.1056/NEJMra035021}}</ref>
'''Monitoring diuresis''': Diuresis can be monitored by weighing the patient daily. The goal is weight loss of no more than 1.0 kg/day for patients with both ascites and [[peripheral edema]] and no more than 0.5 kg/day for patients with ascites alone.<ref name="pmid4910836">{{cite journal |author=Shear L, Ching S, Gabuzda GJ |title=Compartmentalization of ascites and edema in patients with hepatic cirrhosis |journal=N. Engl. J. Med. |volume=282 |issue=25 |pages=1391-6 |year=1970 |pmid=4910836 |doi=}}</ref>
If daily weights cannot be obtained, diuretics can also be guided by the urinary sodium concentration. Dosage is increased until a negative sodium balance occurs.<ref name="pmid8277955"/>  A random urine sodium-to-potassium ratio of > 1 is 90% [[sensitivity (tests)|sensitivity]] in predicting negative balance (> 78-mmol/day sodium excretion).<ref name="Runyon1996">Runyon BA, Heck M. Utility of 24-hour urine sodium collection and urine Na/K ratios in the management of patients with cirrhosis and ascites [abstract]. Hepatology. 1996;24:571A.</ref>
'''Diuretic resistance''': Diuretic resistance can be predicted by giving 80 mg intravenous furosemide after 3 days without diuretics and on a 80 mEq sodium/day diet.  The urinary sodium excretion over 8 hours < 50 mEq/8 hours predicts resistance.<ref name="pmid11124817">{{cite journal |author=Spahr L, Villeneuve JP, Tran HK, Pomier-Layrargues G |title=Furosemide-induced natriuresis as a test to identify cirrhotic patients with refractory ascites |journal=Hepatology |volume=33 |issue=1 |pages=28-31 |year=2001 |pmid=11124817 |doi=10.1053/jhep.2001.20646}}</ref>
====Water restriction====
Water restriction is needed if hyponatremia < 130 mmol per liter develops.<ref name="pmid15084697"/>
====Paracentesis====
{{main|Paracentesis}}
In those with severe (tense) ascites, therapeutic [[paracentesis]] may be needed in addition to medical treatments listed above.<ref name="pmid3297907"/><ref name="pmid3655306"/> As this may deplete [[serum albumin]] levels in the blood, albumin is generally administered intravenously in proportion to the amount of ascites removed.
====Liver transplantation====
{{main|liver transplantation}}
Ascites that is refractory to medical therapy is considered an indication for [[liver transplantation]]. In the United States, the MELD score ([http://www.unos.org/resources/meldPeldCalculator.asp online calculator])<ref name="pmid2682175">{{cite journal |author=Cosby RL, Yee B, Schrier RW |title=New classification with prognostic value in cirrhotic patients |journal=Mineral and electrolyte metabolism |volume=15 |issue=5 |pages=261-6 |year=1989 |pmid=2682175 |doi=}}</ref> is used to prioritize patients for transplantation.
 
====Shunting====
In a minority of the patient with advanced cirrhosis that have recurrent ascites, shunts may be used. Typical shunts used are [[portacaval shunt]], [[peritoneovenous shunt]], and the [[transjugular intrahepatic portosystemic shunt]] (TIPS). However, none of these shunts has been shown to extend life expectancy, and are considered to be bridges to [[liver transplantation]].
A [[meta-analysis]] of [[randomized controlled trials]] by the international [[Cochrane Collaboration]] concluded that "TIPS was more effective at removing ascites as compared with paracentesis...however, TIPS patients develop hepatic encephalopathy significantly more often"
<ref name="pmid17054221">{{cite journal |author=Saab S, Nieto JM, Lewis SK, Runyon BA |title=TIPS versus paracentesis for cirrhotic patients with refractory ascites |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD004889 |year=2006 |pmid=17054221 |doi=10.1002/14651858.CD004889.pub2}}</ref>
 
===Low SAAG===
Exudative ascites generally does not respond to manipulation of the salt balance or diuretic therapy. Repeated paracentesis and treatment of the underlying cause is the mainstay of treatment.
 
==Complications==
===Spontaneous bacterial peritonitis===
{{main|Spontaneous bacterial peritonitis}}
 
==References==
{{reflist|2}}
 
{{SIB}}
{{Symptoms and signs}}
 
[[ar:استسقاء (مرض)]]
[[de:Aszites]]
[[es:Ascitis]]
[[fr:Ascite]]
[[it:Ascite]]
[[nl:Ascites (medisch)]]
[[ja:腹水]]
[[pt:Ascite]]
[[sv:Ascites]]
[[uk:Асцит]]
[[pl:Wodobrzusze]]
[[tr:Asit]]
 
[[Category:Gastroenterology]]
[[Category:Signs and symptoms]]


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Latest revision as of 13:25, 26 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]

Synonyms and keywords: Peritoneal cavity fluid, Peritoneal fluid excess, Hydroperitoneum, Abdominal dropsy, Excess peritoneal fluid.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Common Causes | System based | Alphabetical order

Differentiating Ascites from other Conditions

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Paracentesis | Electrocardiogram | Chest X Ray | CT Scan | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1