https://wikem.org/w/index.php?action=history&feed=atom&title=Ascites%2Fen 2026-04-19T20:33:31Z Revision history for this page on the wiki MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Ascites/en&diff=379966&oldid=prev 2026-01-06T21:11:42Z

<p>Updating to match new version of source page</p> <p><b>New page</b></p><div>&lt;languages/&gt;<br /> <br /> ==Background==<br /> <br /> [[File:Scheme body cavities-en.png|thumb|Lateral view showing abdominopelvic cavity.]]<br /> *Abnormal buildup of peritoneal fluid<br /> *Most commonly caused by portal hypertension<br /> *Ascites fluid can become infected (spontaneous bacterial peritonitis), carrying a mortality rate between 30%-90%&lt;ref&gt;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&lt;/ref&gt;<br /> <br /> <br /> ===Causes===<br /> <br /> *[[Special:MyLanguage/Cirrhosis|Cirrhosis]] 81%&lt;ref&gt;Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.&lt;/ref&gt;<br /> *Malignancy 10%<br /> *[[Special:MyLanguage/Heart failure|Heart failure]] 3%<br /> *[[Special:MyLanguage/Tuberculosis|Tuberculosis]] 2%<br /> *Other 4%<br /> <br /> <br /> ==Clinical Features==<br /> <br /> [[File:Hepaticfailure.jpg|thumb||[[Special:MyLanguage/Ascites|Ascites]] secondary to [[Special:MyLanguage/cirrhosis|cirrhosis]].]]<br /> *[[Special:MyLanguage/Abdominal distention|Abdominal distention]] +/- discomfort<br /> *Fluid wave<br /> *+/- [[Special:MyLanguage/SOB|SOB]] if massive amount<br /> <br /> <br /> ==Differential Diagnosis==<br /> <br /> {{DDX abdominal distention}}<br /> <br /> {{Hepatomegaly DDX}}<br /> <br /> <br /> ==Evaluation==<br /> <br /> [[File:Auscities.png|thumb|Ascites appearance on ultrasound]]<br /> [[File:Ascites Alerhand.gif|thumbnail|POCUS showing ascites&lt;ref&gt;http://www.thepocusatlas.com/bowel/&lt;/ref&gt;]]<br /> [[File:CirrhosisWithAscitesMark.png|thumb|Liver cirrhosis with ascites on CT]]<br /> ''Ascites in females with no other reason for it = gynecologic neoplasm until proven otherwise (ovarian cancer)''<br /> <br /> <br /> ===Workup===<br /> <br /> *CBC<br /> *Chem 7<br /> *PT/PTT<br /> *[[Special:MyLanguage/LFTs|LFTs]] + lipase<br /> *[[Special:MyLanguage/FAST|FAST]]<br /> <br /> <br /> ====Ascites Fluid Workup====<br /> <br /> *Cell count and differential<br /> *Albumin<br /> *Total protein<br /> *Only if suspicious:&lt;ref name=Runyon2012&gt;Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.&lt;/ref&gt;<br /> **[[Special:MyLanguage/Gram stain|Gram stain]]<br /> **Glucose<br /> **LDH<br /> **Amylase<br /> **AFB smear and culture<br /> **Cytology<br /> **Triglyceride<br /> <br /> {{Ascites Evaluation}}<br /> <br /> <br /> ==Management==<br /> <br /> *Salt restriction<br /> **Effective in about 15% of patients<br /> *[[Special:MyLanguage/Diuretics|Diuretics]]<br /> **[[Special:MyLanguage/Spironolactone|Spironolactone]]<br /> ***Starting dose = 100mg/day PO (max 400mg/day)<br /> ***40% of patients will respond <br /> **[[Special:MyLanguage/Furosemide|Furosemide]]<br /> ***40mg/day PO (max 160mg/day)<br /> ***Ratio of 100:40 with spironolactone (reduces risks of potassium prob)<br /> *Water restriction<br /> *[[Special:MyLanguage/Paracentesis|Paracentesis]]<br /> *Consider liver transplantation and shunting<br /> <br /> <br /> ==Disposition==<br /> <br /> *Frequently outpatient, once [[Special:MyLanguage/SBP|SBP]] is ruled out, if a known reason for ascites and sufficiently therapeutically drained<br /> <br /> <br /> ==Complications==<br /> <br /> *[[Special:MyLanguage/SBP|SBP]]<br /> *[[Special:MyLanguage/Hepatorenal syndrome|Hepatorenal syndrome]]<br /> *[[Special:MyLanguage/Pleural effusion|Pleural effusion]]<br /> <br /> <br /> ==See Also==<br /> <br /> *[[Special:MyLanguage/Jaundice|Jaundice]]<br /> *[[Special:MyLanguage/Paracentesis|Paracentesis]]<br /> *[[Special:MyLanguage/SBP|SBP]]<br /> *[[Special:MyLanguage/Cirrhosis|Cirrhosis]]<br /> *[[Special:MyLanguage/Acute hepatic failure|Acute hepatic failure]]<br /> <br /> <br /> ==References==<br /> <br /> &lt;references/&gt;<br /> [[Category:GI]]<br /> [[Category:Symptoms]]</div>

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