Ascites - Revision history

Ostermayer: Marked this version for translation

2026-01-06T20:35:14Z

Marked this version for translation

← Older revision		Revision as of 20:35, 6 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	[[File:Scheme body cavities-en.png\|thumb\|Lateral view showing abdominopelvic cavity.]]		[[File:Scheme body cavities-en.png\|thumb\|Lateral view showing abdominopelvic cavity.]]
	*Abnormal buildup of peritoneal fluid		*Abnormal buildup of peritoneal fluid
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	===Causes===		===Causes=== <!--T:3-->

			<!--T:4-->
	*[[Special:MyLanguage/Cirrhosis\|Cirrhosis]] 81%<ref>Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.</ref>		*[[Special:MyLanguage/Cirrhosis\|Cirrhosis]] 81%<ref>Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.</ref>
	*Malignancy 10%		*Malignancy 10%
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	==Clinical Features==		==Clinical Features== <!--T:5-->

			<!--T:6-->
	[[File:Hepaticfailure.jpg\|thumb\|\|[[Special:MyLanguage/Ascites\|Ascites]] secondary to [[Special:MyLanguage/cirrhosis\|cirrhosis]].]]		[[File:Hepaticfailure.jpg\|thumb\|\|[[Special:MyLanguage/Ascites\|Ascites]] secondary to [[Special:MyLanguage/cirrhosis\|cirrhosis]].]]
	*[[Special:MyLanguage/Abdominal distention\|Abdominal distention]] +/- discomfort		*[[Special:MyLanguage/Abdominal distention\|Abdominal distention]] +/- discomfort
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:7-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:8-->

			<!--T:9-->
	[[File:Auscities.png\|thumb\|Ascites appearance on ultrasound]]		[[File:Auscities.png\|thumb\|Ascites appearance on ultrasound]]
	[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]		[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]
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	===Workup===		===Workup=== <!--T:10-->

			<!--T:11-->
	*CBC		*CBC
	*Chem 7		*Chem 7
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	====Ascites Fluid Workup====		====Ascites Fluid Workup==== <!--T:12-->

			<!--T:13-->
	*Cell count and differential		*Cell count and differential
	*Albumin		*Albumin
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	==Management==		==Management== <!--T:14-->

			<!--T:15-->
	*Salt restriction		*Salt restriction
	**Effective in about 15% of patients		**Effective in about 15% of patients
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	==Disposition==		==Disposition== <!--T:16-->

			<!--T:17-->
	*Frequently outpatient, once [[Special:MyLanguage/SBP\|SBP]] is ruled out, if a known reason for ascites and sufficiently therapeutically drained		*Frequently outpatient, once [[Special:MyLanguage/SBP\|SBP]] is ruled out, if a known reason for ascites and sufficiently therapeutically drained


	==Complications==		==Complications== <!--T:18-->

			<!--T:19-->
	*[[Special:MyLanguage/SBP\|SBP]]		*[[Special:MyLanguage/SBP\|SBP]]
	*[[Special:MyLanguage/Hepatorenal syndrome\|Hepatorenal syndrome]]		*[[Special:MyLanguage/Hepatorenal syndrome\|Hepatorenal syndrome]]
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	==See Also==		==See Also== <!--T:20-->

			<!--T:21-->
	*[[Special:MyLanguage/Jaundice\|Jaundice]]		*[[Special:MyLanguage/Jaundice\|Jaundice]]
	*[[Special:MyLanguage/Paracentesis\|Paracentesis]]		*[[Special:MyLanguage/Paracentesis\|Paracentesis]]
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	==References==		==References== <!--T:22-->

			<!--T:23-->
	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:42:22Z

Prepared the page for translation

← Older revision		Revision as of 21:42, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Scheme body cavities-en.png\|thumb\|Lateral view showing abdominopelvic cavity.]]		[[File:Scheme body cavities-en.png\|thumb\|Lateral view showing abdominopelvic cavity.]]
	*Abnormal buildup of peritoneal fluid		*Abnormal buildup of peritoneal fluid
	*Most commonly caused by portal hypertension		*Most commonly caused by portal hypertension
	*Ascites fluid can become infected (spontaneous bacterial peritonitis), carrying a mortality rate between 30%-90%<ref>Sundaram V, Manne V, Al-Osaimi AM. Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers. Saudi J Gastroenterol. 2014;20(5):279-287. doi:10.4103/1319-3767.141686</ref>		*Ascites fluid can become infected (spontaneous bacterial peritonitis), carrying a mortality rate between 30%-90%<ref>Sundaram V, Manne V, Al-Osaimi AM. Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers. Saudi J Gastroenterol. 2014;20(5):279-287. doi:10.4103/1319-3767.141686</ref>


	===Causes===		===Causes===
	*[[Cirrhosis]] 81%<ref>Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.</ref>
			*[[Special:MyLanguage/Cirrhosis\|Cirrhosis]] 81%<ref>Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.</ref>
	*Malignancy 10%		*Malignancy 10%
	*[[Heart failure]] 3%		*[[Special:MyLanguage/Heart failure\|Heart failure]] 3%
	*[[Tuberculosis]] 2%		*[[Special:MyLanguage/Tuberculosis\|Tuberculosis]] 2%
	*Other 4%		*Other 4%


	==Clinical Features==		==Clinical Features==
	[[File:Hepaticfailure.jpg\|thumb\|\|[[Ascites]] secondary to [[cirrhosis]].]]
	*[[Abdominal distention]] +/- discomfort		[[File:Hepaticfailure.jpg\|thumb\|\|[[Special:MyLanguage/Ascites\|Ascites]] secondary to [[Special:MyLanguage/cirrhosis\|cirrhosis]].]]
			*[[Special:MyLanguage/Abdominal distention\|Abdominal distention]] +/- discomfort
	*Fluid wave		*Fluid wave
	*+/- [[SOB]] if massive amount		*+/- [[Special:MyLanguage/SOB\|SOB]] if massive amount


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{DDX abdominal distention}}		{{DDX abdominal distention}}
			<translate>
			</translate>
	{{Hepatomegaly DDX}}		{{Hepatomegaly DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:Auscities.png\|thumb\|Ascites appearance on ultrasound]]		[[File:Auscities.png\|thumb\|Ascites appearance on ultrasound]]
	[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]		[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]
	[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]		[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]
	''Ascites in females with no other reason for it = gynecologic neoplasm until proven otherwise (ovarian cancer)''		''Ascites in females with no other reason for it = gynecologic neoplasm until proven otherwise (ovarian cancer)''


	===Workup===		===Workup===

	*CBC		*CBC
	*Chem 7		*Chem 7
	*PT/PTT		*PT/PTT
	*[[LFTs]] + lipase		*[[Special:MyLanguage/LFTs\|LFTs]] + lipase
	*[[FAST]]		*[[Special:MyLanguage/FAST\|FAST]]


	====Ascites Fluid Workup====		====Ascites Fluid Workup====

	*Cell count and differential		*Cell count and differential
	*Albumin		*Albumin
	*Total protein		*Total protein
	*Only if suspicious:<ref name=Runyon2012>Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.</ref>		*Only if suspicious:<ref name=Runyon2012>Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.</ref>
	**[[Gram stain]]		**[[Special:MyLanguage/Gram stain\|Gram stain]]
	**Glucose		**Glucose
	**LDH		**LDH
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	**Triglyceride		**Triglyceride

			</translate>
	{{Ascites Evaluation}}		{{Ascites Evaluation}}
			<translate>


	==Management==		==Management==

	*Salt restriction		*Salt restriction
	**Effective in about 15% of patients		**Effective in about 15% of patients
	*[[Diuretics]]		*[[Special:MyLanguage/Diuretics\|Diuretics]]
	**[[Spironolactone]]		**[[Special:MyLanguage/Spironolactone\|Spironolactone]]
	***Starting dose = 100mg/day PO (max 400mg/day)		***Starting dose = 100mg/day PO (max 400mg/day)
	***40% of patients will respond		***40% of patients will respond
	**[[Furosemide]]		**[[Special:MyLanguage/Furosemide\|Furosemide]]
	***40mg/day PO (max 160mg/day)		***40mg/day PO (max 160mg/day)
	***Ratio of 100:40 with spironolactone (reduces risks of potassium prob)		***Ratio of 100:40 with spironolactone (reduces risks of potassium prob)
	*Water restriction		*Water restriction
	*[[Paracentesis]]		*[[Special:MyLanguage/Paracentesis\|Paracentesis]]
	*Consider liver transplantation and shunting		*Consider liver transplantation and shunting


	==Disposition==		==Disposition==
	*Frequently outpatient, once [[SBP]] is ruled out, if a known reason for ascites and sufficiently therapeutically drained
			*Frequently outpatient, once [[Special:MyLanguage/SBP\|SBP]] is ruled out, if a known reason for ascites and sufficiently therapeutically drained


	==Complications==		==Complications==
	*[[SBP]]
	*[[Hepatorenal syndrome]]		*[[Special:MyLanguage/SBP\|SBP]]
	*[[Pleural effusion]]		*[[Special:MyLanguage/Hepatorenal syndrome\|Hepatorenal syndrome]]
			*[[Special:MyLanguage/Pleural effusion\|Pleural effusion]]


	==See Also==		==See Also==
	*[[Jaundice]]
	*[[Paracentesis]]		*[[Special:MyLanguage/Jaundice\|Jaundice]]
	*[[SBP]]		*[[Special:MyLanguage/Paracentesis\|Paracentesis]]
	*[[Cirrhosis]]		*[[Special:MyLanguage/SBP\|SBP]]
	*[[Acute hepatic failure]]		*[[Special:MyLanguage/Cirrhosis\|Cirrhosis]]
			*[[Special:MyLanguage/Acute hepatic failure\|Acute hepatic failure]]


	==References==		==References==

	<references/>		<references/>
	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

Rossdonaldson1: /* Background */

2024-02-07T22:20:34Z

Background

← Older revision		Revision as of 22:20, 7 February 2024
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Scheme body cavities-en.png\|thumb\|Lateral view showing abdominopelvic cavity.]]
	*Abnormal buildup of peritoneal fluid		*Abnormal buildup of peritoneal fluid
	*Most commonly caused by portal hypertension		*Most commonly caused by portal hypertension

Rossdonaldson1: /* Differential Diagnosis */

2022-09-07T20:57:24Z

Differential Diagnosis

← Older revision		Revision as of 20:57, 7 September 2022
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{DDX abdominal distention}}		{{DDX abdominal distention}}
			{{Hepatomegaly DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Evaluation */

2022-09-07T19:43:53Z

Evaluation

← Older revision		Revision as of 19:43, 7 September 2022
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	[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]		[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]
	[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]		[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]
	*Ascites in females with no other reason for it = ~~gyn~~ neoplasm until proven otherwise (ovarian cancer)		''Ascites in females with no other reason for it = gynecologic neoplasm until proven otherwise (ovarian cancer)''

	===Workup===		===Workup===

Rossdonaldson1 at 15:51, 6 October 2021

2021-10-06T15:51:20Z

← Older revision		Revision as of 15:51, 6 October 2021
Line 2:		Line 2:
	*Abnormal buildup of peritoneal fluid		*Abnormal buildup of peritoneal fluid
	*Most commonly caused by portal hypertension		*Most commonly caused by portal hypertension
	*Ascites fluid can become infected ([[spontaneous bacterial peritonitis]]), carrying a mortality rate between 30%-90%<ref>Sundaram V, Manne V, Al-Osaimi AM. Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers. Saudi J Gastroenterol. 2014;20(5):279-287. doi:10.4103/1319-3767.141686</ref>		*Ascites fluid can become infected (spontaneous bacterial peritonitis), carrying a mortality rate between 30%-90%<ref>Sundaram V, Manne V, Al-Osaimi AM. Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers. Saudi J Gastroenterol. 2014;20(5):279-287. doi:10.4103/1319-3767.141686</ref>

	===Causes===		===Causes===
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	[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]		[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]
	[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]		[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]
	*Ascites in females with no other reason = ~~gynecologic~~ neoplasm until proven otherwise (~~e.g.~~ ovarian cancer)		*Ascites in females with no other reason for it = gyn neoplasm until proven otherwise (ovarian cancer)
	**Discuss with gynecology before performing [[paracentesis]] for the <u>first time</u> on such patients, given theoretical risk of seeding the abdominal wall with cancer cells

	===Workup===		===Workup===
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	*[[FAST]]		*[[FAST]]

	====~~[[Paracentesis]] for~~ Ascites Fluid Workup====		====Ascites Fluid Workup====
	*Cell count and differential		*Cell count and differential
	*Albumin		*Albumin
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	*[[Cirrhosis]]		*[[Cirrhosis]]
	*[[Acute hepatic failure]]		*[[Acute hepatic failure]]

	~~==External Links==~~
	*[https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/ascites Merck Manual - Ascites]
	*[https://coreem.net/journal-reviews/paracentesis-for-all/ Core EM - Should All Admitted Patients with Ascites Get a Paracentesis?]

	==References==		==References==

Rossdonaldson1: /* Evaluation */

2021-09-25T10:21:26Z

Evaluation

← Older revision		Revision as of 10:21, 25 September 2021
Line 24:		Line 24:
	[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]		[[File:Ascites Alerhand.gif\|thumbnail\|POCUS showing ascites<ref>http://www.thepocusatlas.com/bowel/</ref>]]
	[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]		[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]
	*Ascites in females with no other reason ~~for it~~ = ~~gyn~~ neoplasm until proven otherwise (ovarian cancer)		*Ascites in females with no other reason = gynecologic neoplasm until proven otherwise (e.g. ovarian cancer)
			**Discuss with gynecology before performing [[paracentesis]] for the <u>first time</u> on such patients, given theoretical risk of seeding the abdominal wall with cancer cells

	===Workup===		===Workup===

Rossdonaldson1: /* Evaluation */

2021-09-25T10:18:36Z

Evaluation

← Older revision		Revision as of 10:18, 25 September 2021
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	*[[FAST]]		*[[FAST]]

	====Ascites Fluid Workup====		====[[Paracentesis]] for Ascites Fluid Workup====
	*Cell count and differential		*Cell count and differential
	*Albumin		*Albumin

Rossdonaldson1 at 10:17, 25 September 2021

2021-09-25T10:17:20Z

← Older revision		Revision as of 10:17, 25 September 2021
Line 2:		Line 2:
	*Abnormal buildup of peritoneal fluid		*Abnormal buildup of peritoneal fluid
	*Most commonly caused by portal hypertension		*Most commonly caused by portal hypertension
	*Ascites fluid can become infected (spontaneous bacterial peritonitis), carrying a mortality rate between 30%-90%<ref>Sundaram V, Manne V, Al-Osaimi AM. Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers. Saudi J Gastroenterol. 2014;20(5):279-287. doi:10.4103/1319-3767.141686</ref>		*Ascites fluid can become infected ([[spontaneous bacterial peritonitis]]), carrying a mortality rate between 30%-90%<ref>Sundaram V, Manne V, Al-Osaimi AM. Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers. Saudi J Gastroenterol. 2014;20(5):279-287. doi:10.4103/1319-3767.141686</ref>


	===Causes===		===Causes===

Blsimpso at 16:57, 21 September 2021

2021-09-21T16:57:22Z

← Older revision		Revision as of 16:57, 21 September 2021
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	*[[Cirrhosis]]		*[[Cirrhosis]]
	*[[Acute hepatic failure]]		*[[Acute hepatic failure]]

			==External Links==
			*[https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/ascites Merck Manual - Ascites]
			*[https://coreem.net/journal-reviews/paracentesis-for-all/ Core EM - Should All Admitted Patients with Ascites Get a Paracentesis?]

	==References==		==References==