Ascites

Ascites term for an accumulation of fluid in the peritoneal cavity. Th emedical condition is also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more archaically as abdominal dropsy Signs and Symptoms 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. Ascites is detected on physical examination of the abdomen by visible 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" (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). 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 tocancer (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.\ Causes The Serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites Causes of high SAAG ("transudate") are:
[3]

Cirrhosis - 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%) Heart failure - 3% Hepatic Venous occlusion: Budd-Chiari syndrome or veno-occlusive disease Constrictive pericarditis Kwashiorkor

Causes of low SAAG ("exudate") are:

Cancer (primary peritoneal carcinomatosis and metastasis) - 10% Infection: Tuberculosis - 2% or Spontaneous bacterial peritonitis Pancreatitis - 1% Serositis Nephrotic syndrome or Protein losing enteropathy Hereditary angioedema
[5]

Other Rare causes: Meigs syndrome Vasculitis Hypothyroidism Renal Dialysis Peritoneum Mesothelioma

Ascites
Portal hypertension - ascites

Last reviewed: December 13, 2010.

Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity). See also:

Alcoholic liver disease Cirrhosis Causes, incidence, and risk factors

A person with ascites usually has severe liver disease. Ascites due to liver disease is caused by high pressure in the blood vessels of the liver (portal hypertension) and low albumin levels. Disorders that may be associated with ascites include:

Cirrhosis and any illness that leads to it Clots in the veins of the liver (portal vein thrombosis) Colon cancer Congestive heart failure Constrictive pericarditis Hepatitis Infections such as tuberculosis Liver cancer Nephrotic syndrome Ovarian cancer, endometrial cancer Pancreatitis Pancreatic cancer Protein-losing enteropathy

Kidney dialysis may also be associated with ascites.

Signs and tests

A physical examination may reveal a swollen abdomen, or belly. Test to evaluate the liver may be done, including:

24-hour urine collection Creatinine and electrolytes Kidney function tests Liver enzyme, bilirubin, coagulation, and serum protein tests Urinalysis

Paracentesis or abdominal tap may be performed. This procedure involves using a thin needle to pull fluid from the abdomen. The fluid is tested in various ways to determine the cause of ascites.

Ascites
Definition
Ascites is an abnormal accumulation of fluid in the abdomen.

Description
Rapidly developing (acute) ascites can occur as a complication of trauma, perforated ulcer, appendicitis, or inflammation of the colon or other tube-shaped organ (diverticulitis). This condition can also develop when intestinal fluids, bile, pancreatic juices, or bacteria invade or inflame the smooth, transparent membrane that lines the inside of the abdomen (peritoneum). However, ascites is more often associated with liver disease and other long-lasting (chronic) conditions. Types of ascites Cirrhosis, which is responsible for 80% of all instances of ascities in the United States, triggers a series of disease-producing changes that weaken the kidney's ability to excrete sodium in the urine. Pancreatic ascites develops when a cyst that has thick, fibrous walls (pseudocyst) bursts and permits pancreatic juices to enter the abdominal cavity. Chylous ascites has a milky appearance caused by lymph that has leaked into the abdominal cavity. Although chylous ascites is sometimes caused by trauma, abdominal surgery, tuberculosis, or another peritoneal infection, it is usually a symptom of lymphoma or some other cancer. Cancer causes 10% of all instances of ascites in the United States. It is most commonly a consequence of disease that originates in the peritoneum (peritoneal carcinomatosis) or of cancer that spreads (metastasizes) from another part of the body. Endocrine and renal ascites are rare disorders. Endocrine ascites, sometimes a symptom of an endocrine system disorder, also affects women who are taking fertility drugs. Renal ascites develops when blood levels of albumin dip below normal. Albumin is the major protein in blood plasma. It functions to keep fluid inside the blood vessels.

Causes and symptoms

Causes The two most important factors in the production of ascites due to chronic liver disease are:

Low levels of albumin in the blood that cause a change in the pressure necessary to prevent fluid exchange (osmotic pressure). This change in pressure allows fluid to seep out of the blood vessels. An increase in the pressure within the branches of the portal vein that run through liver (portal hypertension). Portal hypertension is caused by the scarring that occurs in cirrhosis. Blood that cannot flow through the liver because of the increased pressure leaks into the abdomen and causes ascites.

Other conditions that contribute to ascites development include:

hepatitis heart or kidney failure inflammation and fibrous hardening of the sac that contains the heart (constrictive pericarditis)

Persons who have systemic lupus erythematosus but do not have liver disease or portal hypertension occasionally develop ascites. Depressed thyroid activity sometimes causes pronounced ascites, but inflammation of the pancreas (pancreatitis) rarely causes significant accumulations of fluid. Symptoms Small amounts of fluid in the abdomen do not usually produce symptoms. Massive accumulations may cause:

rapid weight gain abdominal discomfort and distention shortness of breath swollen ankles