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Ascites

Ascites is a pathologic accumulation of fluid within the abdominal cavity. The fluid can accumulate as an exudate or a transudate.


Presentation

  • Large cystic ovarian tumours can present masquerading as massive ascites and misleading diagnosis as in this case report. We report this case to increase the suspicion index of a large ovarian cyst in all women presenting with massive ascites.[ncbi.nlm.nih.gov]
  • The intra-pericardial paraganglioma is very rare and most of them present with hypertension or palpitations.[ncbi.nlm.nih.gov]
  • The studies intimate the possibility that AGP present in ascites might reduce the activity of lurbinectedin and to a lesser extent of trabectedin against ovarian cancer cells present in ascites.[ncbi.nlm.nih.gov]
  • We present a 4-week-old neonate with acute onset of bloody stools and abdominal distention.[ncbi.nlm.nih.gov]
  • We present a case of a 37 years old multiparous lady who presented with such a classical picture. Radiological picture was suggestive of ovarian carcinoma with peritoneal metastasis. However, ascitic fluid cytology was negative for malignant cells.[ncbi.nlm.nih.gov]
Pleural Effusion
  • The Dengue Score is a model for predicting pleural effusion and/or ascites and uses the hematocrit (Hct), albumin concentration, platelet count and aspartate aminotransferase (AST) ratio as independent variables.[ncbi.nlm.nih.gov]
  • We present three cases of endometriosis-related ascites, one of them with pleural effusion.[ncbi.nlm.nih.gov]
  • A patient will also have lower limb edema and pleural effusion (fluid passing between the two layers of the pleura, which covers the lungs). Diagnosis The diagnosis of ascites is not easy when manifested in small quantities.[health.ccm.net]
  • Malignancy (10%) Heart failure (3%) TB (1%) Investigations in ascites Blood FBC (anaemia and platelets), U&E, LFT, clotting, gas for pH Imaging Abdominal USS Liver mets, hepatic vein and artery Doppler, splenomegaly (portal HTN) Chest x-ray may show pleural[oxfordmedicaleducation.com]
  • CXR may show pleural effusion, evidence of pulmonary metastases or heart failure. If ultrasound has failed to reveal a cause then MRI scanning may be used. Invasive procedures See separate Ascites Tapping article.[patient.info]
Dyspnea
  • Because of dyspnea, paracentesis was performed in all cases. Median AsI at which patients reported dyspnea was 29.0 cm (range 21.6-38.6 cm). At AsI values less than 21.6 cm, no dyspnea was observed in any of the 12 studied patients.[ncbi.nlm.nih.gov]
  • People with ascites may experience the following symptoms: Weight gain Shortness of breath, also called dyspnea Abdominal swelling Sense of fullness or bloating Sense of heaviness Indigestion Nausea or vomiting Changes to the belly button Hemorrhoids,[cancer.net]
  • This crowding upward of the diaphragm gives rise to more or less dyspnea, and the patient soon finds himself unable to lie down. Gastric disturbances are common, and constipation is the rule.[henriettes-herb.com]
  • Emergency Management Emergency measures are required for large, tense ascites that causes dyspnea, hypoxia and/or severe abdominal discomfort. Such patients benefit from emergent large-volume paracentesis.[clinicaladvisor.com]
Orthopnea
  • The shortness of breath tends to be worse with activity and with lying flat (orthopnea). Patients with ascites due to heart failure tend to waken in the middle of the night, with paroxysmal nocturnal dyspnea (dys abnormal pnea breathing).[emedicinehealth.com]
  • Patients with heart failure usually report paroxysmal nocturnal dyspnea, orthopnea and peripheral edema. Any history of infectious exposures, including tuberculosis, should be queried.[clinicaladvisor.com]
  • Patients with malignant ascites may have symptoms related to the underlying malignancy, such as weight loss, whereas patients with ascites due to heart failure may have dyspnea, orthopnea, congested neck veins, and lower limb edema.[intechopen.com]
Weight Gain
  • Episodic angio-oedema with eosinophilia (EAE) or Gleich's syndrome is a rare condition characterised by recurrent episodes of oedema and eosinophilia, accompanied by urticaria, fever and weight gain.[ncbi.nlm.nih.gov]
  • A 57-year-old woman presents with an adnexal mass and recent weight gain but otherwise feels well. A 65-year-old man with a history of myocardial infarction is admitted for decreased exercise tolerance, increased abdominal girth, and ankle edema.[jamaevidence.mhmedical.com]
  • When mycophenolate was recommenced abdominal fullness and weight gain reoccurred. The patient had to be switched to long-term azathioprine treatment. More than 1 year post-conversion the patient remains free of ascites.[ncbi.nlm.nih.gov]
  • gain, depending on the amount of abdominal distension.[radiology.ucla.edu]
  • Try to avoid drinking excess water, which can lead to additional swelling and weight gain. Related Reading: The one thing for a healthy liver Liver-mortality has moved its way to being one of the top 12 causes of death within the United States.[belmarrahealth.com]
Whipple Disease
Abdominal Pain
  • We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby.[ncbi.nlm.nih.gov]
  • Postoperative complications included: infection of the shunt in 3 patients (4.8%), shunt obstruction in 4 (6.4%) and transient abdominal pain in 4 (6.4%). Significant symptomatic relief was obtained in all patients.[ncbi.nlm.nih.gov]
  • All patients were admitted to the hospital because of abdominal pain and dyspnea due to increasing ascites. Ultrasound measurements of ascites extent were performed in four external quadrants of the abdomen. Pockets of free fluid were measured.[ncbi.nlm.nih.gov]
  • pain and increase of abdominal circumference.[ncbi.nlm.nih.gov]
  • ‘Patients present with the insidious onset of ascites, abdominal pain, and fever.’ ‘Signs and symptoms are primarily those of liver cirrhosis and ascites.’[en.oxforddictionaries.com]
Nausea
  • We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby.[ncbi.nlm.nih.gov]
  • Major grade 3 or 4 adverse events were neutropenia (17%), nausea (7%), fatigue (7%), and diarrhea (3%); no treatment-related deaths were observed.[ncbi.nlm.nih.gov]
  • Ascites causes abdominal pain, swelling, nausea, vomiting, and other difficulties.[urmc.rochester.edu]
Vomiting
  • We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby.[ncbi.nlm.nih.gov]
  • Children may eat smaller portions and can vomit due to limited space in the abdomen. A dietician will be able to advise and support you. CLDF has a leaflet on nutrition with further information.[childliverdisease.org]
  • Ascites causes abdominal pain, swelling, nausea, vomiting, and other difficulties.[urmc.rochester.edu]
Abdominal Distension
  • Here we report a case of a 46-year-old HIV positive female who presented to us with ascites and abdominal distension with peripheral eosinophilia and diagnosed as EGE.[ncbi.nlm.nih.gov]
  • An 81-year-old man was admitted to our hospital with abdominal distension due to refractory ascites of unknown origin. He subsequently died of aspiration pneumonia.[ncbi.nlm.nih.gov]
  • These patients usually present with abdominal distension, pelvic pain, and weight loss, but a careful questioning usually reveals the typical endometriosis symptoms-such as dysmenorrhea and dyspareunia.[ncbi.nlm.nih.gov]
  • Abdominal distension Bloating Weight gain or weight loss with increased abdominal distension Abdominal pain Shortness of breath Edema (swelling) in legs Bruising Encephalopathy Diagnosis Ascites can be detected with a physical exam or ultrasound.[radiology.ucla.edu]
  • Ascites needs to be differentiated from other causes of abdominal distension including bowel obstruction, bleeding and huge intra-abdominal masses or cysts.[surgwiki.com]
Increased Abdominal Girth
  • Patients can complain of increasing abdominal girth, generalized abdominal pain and shortness of breath. Weight loss is a relatively non-specific symptom, but may be more common in those with an underlying malignancy.[cancertherapyadvisor.com]
  • abdominal girth, early satiety, and respiratory distress depending on the amount of fluid accumulated in the abdomen.[hepatitiscentral.com]
  • Finally, the patient may have increased abdominal girth for reasons other than ascites, such as obesity, tumor, large intra-abdominal cysts, or bowel obstruction. B.[clinicaladvisor.com]
Heart Failure
  • A 65-year-old patient was admitted to our institution due to anasarca and pulmonary congestion, mimicking heart failure. We started the patient on diuretics and vasodilators.[ncbi.nlm.nih.gov]
  • "Heart Failure Society of America (HFSA) 2006 Comprehensive Heart Failure Practice Guideline". J Cardiac Failure . 12 (1): e1–e122. doi : 10.1016/j.cardfail.2005.11.005 . PMID 16500560 . Cosby RL, Yee B, Schrier RW (1989).[en.wikipedia.org]
  • Ascites is the most frequent complication of cirrhosis and occurs only when the portal hypertension has already installed but ascites is caused by neoplasms, heart failure, tuberculosis, pancreatic illnesses, as well as other kind of affections.[ncbi.nlm.nih.gov]
  • For example, peritoneal carcinomatosis or malignant ascites may be treated by surgical resection of the cancer and chemotherapy , while management of ascites related to heart failure is directed toward treating heart failure with medical management and[medicinenet.com]

Workup

  • Further workup revealed that the patient was HIV-positive and the ascitic tap showed haemorrhagic fluid.[ncbi.nlm.nih.gov]
Hepatocellular Carcinoma
  • Multivariate analysis showed that the presence of viable hepatocellular carcinoma (hazards ratio [HR] 2.14, p 0.02) and a decrease in diuretics were independently prognostic of survival (HR 0.36, p 0.01).[ncbi.nlm.nih.gov]
  • Thirty-five patients with refractory ascites related to liver cirrhosis and/or hepatocellular carcinoma (HCC) who underwent PVS placement between February 2005 and February 2013 were included in the study.[ncbi.nlm.nih.gov]
  • Of these, six patients had hepatocellular carcinoma and cirrhosis (5 in PleurX group). None were eligible for insertion of a TIPS or liver transplantation.[ncbi.nlm.nih.gov]
  • carcinoma ( Cytojournal 2009;6:16 ) Cytology images Images hosted on other servers: Ascites fluid cytology Advertisement[pathologyoutlines.com]
  • Curcumin (CUR), a widely used food additive, is derived mainly from Curcuma species that has been applied traditionally for the treatment of various diseases, including hepatocellular carcinoma (HCC).[ncbi.nlm.nih.gov]
Pleural Effusion
  • The Dengue Score is a model for predicting pleural effusion and/or ascites and uses the hematocrit (Hct), albumin concentration, platelet count and aspartate aminotransferase (AST) ratio as independent variables.[ncbi.nlm.nih.gov]
  • We present three cases of endometriosis-related ascites, one of them with pleural effusion.[ncbi.nlm.nih.gov]
  • A patient will also have lower limb edema and pleural effusion (fluid passing between the two layers of the pleura, which covers the lungs). Diagnosis The diagnosis of ascites is not easy when manifested in small quantities.[health.ccm.net]
  • Malignancy (10%) Heart failure (3%) TB (1%) Investigations in ascites Blood FBC (anaemia and platelets), U&E, LFT, clotting, gas for pH Imaging Abdominal USS Liver mets, hepatic vein and artery Doppler, splenomegaly (portal HTN) Chest x-ray may show pleural[oxfordmedicaleducation.com]
  • CXR may show pleural effusion, evidence of pulmonary metastases or heart failure. If ultrasound has failed to reveal a cause then MRI scanning may be used. Invasive procedures See separate Ascites Tapping article.[patient.info]

Treatment

  • Clinicians are well aware of common adverse reactions related to MPA treatment, in particular diarrhea, leukopenia and infections. Here we report a case of severe, persistent ascites associated with MPA treatment.[ncbi.nlm.nih.gov]
  • The clinical treatment of ovarian cancer with ascites is problematic. The main reasons for treatment failure are the susceptibility to intraperitoneal metastasis and chemotherapeutic drug resistance.[ncbi.nlm.nih.gov]
  • The first-line treatment of uncomplicated ascites is a moderate sodium-restricted diet combined with diuretic treatment. In patients who develop refractory ascites, paracentesis plus albumin represents the most feasible option.[ncbi.nlm.nih.gov]
  • Doses of diuretics should be adjusted appropriately during tolvaptan treatment.[ncbi.nlm.nih.gov]
  • In conclusion, splenic artery embolization is a therapeutic option for the treatment of refractory ascites after liver transplantation.[ncbi.nlm.nih.gov]

Prognosis

  • Objective Hyponatremia is frequently observed in patients with decompensated liver cirrhosis and it is also related to a poor prognosis.[ncbi.nlm.nih.gov]
  • In this pilot study MIR-FEWS more accurately assess the 6-month prognosis of patients with ascites and cirrhosis than the MELD or Child-Pugh scores.[ncbi.nlm.nih.gov]
  • Plasmacytoid urothelial carcinoma (PUC) is a distinct variant of urinary bladder cancer, with a high propensity for invasion and poor prognosis.[ncbi.nlm.nih.gov]
  • Predictive models based on serum cystatin C level instead of serum creatinine level would be more helpful in the assessment of the condition and prognosis of patients with cirrhotic ascites.[ncbi.nlm.nih.gov]
  • Prognosis in ascites 50% mortality over two years, and signifies the need to consider liver transplantation. Refractory ascites carries an even poorer prognosis, 50% patients dying within six months.[oxfordmedicaleducation.com]

Etiology

  • Eosinophilic gastroenteritis (EGE) is an uncommon disease of unknown etiology reported in both adult and pediatric age group.[ncbi.nlm.nih.gov]
  • Ascites is a rare complication of multiple myeloma (MM); in most cases, the direct invasion of myeloma cells to the peritoneal cavity has been assumed to be the etiology because the effusion is usually exudative and contains a high proportion of myeloma[ncbi.nlm.nih.gov]
  • Although no areas of active volvulus were identified intraoperatively, findings in the case were suggestive of small bowel volvulus and deemed as the most likely etiology for this patient's presentation.[ncbi.nlm.nih.gov]
  • After ruling out the main causes of ascites, a portal hyperflow was a potential etiology. This condition perpetuates itself with splenic circulation and brings about a reduction in the hepatic arterial flow.[ncbi.nlm.nih.gov]
  • Determine etiology by performing laboratory and imaging studies. 5. Evaluate for other etiologies if there are no features of cirrhosis. Diagnostic tests 1.[clinicaladvisor.com]

Epidemiology

  • The epidemiology, mechanism and management of patients with this serologic profile are discussed here.[depts.washington.edu]
  • Ascites secondary to infections and malignancy is a direct result of peritoneal inflammation and possible lymphatic outflow obstruction with a characteristically low SAAG of Epidemiology Chronic liver disease is the twelfth leading cause of death in the[clinicaladvisor.com]
  • This work is supported, in part, by the Kyoto University EBM center, non-profit organization Epidemiological & Clinical Research Information network (ECRIN), and by the Osaka Cancer Research Foundation. References 1.[academic.oup.com]
  • Epidemiology of severe hospital-acquired infections in patients with liver cirrhosis: effect of long-term administration of norfloxacin. Clin Infect Dis 1998 ; 26 : 1066 –70.[gut.bmj.com]
Sex distribution
Age distribution

Pathophysiology

  • The recommendations made here are based on pathophysiology and suggest the preferred approach to diagnostic and therapeutic aspects, and preventive care.[ncbi.nlm.nih.gov]
  • This review summarizes current knowledge about the pathophysiology of ascites and explains the appropriate approach to clinical evaluation.[nejm.org]
  • Laparoscopy with peritoneal biopsies Pathophysiology The pathophysiology of ascites is dependent on the underlying cause. Sinusoids, the functional capillary unit of the liver, are characterized by highly permeable and fenestrated endothelium.[clinicaladvisor.com]
  • Medicine (Baltimore) 2016;95:e2877 ) Presence of ascites is associated with poorer overall survival in patients with cirrhosis (1 year 85%, 5 year 56%) ( Clin Gastroenterol Hepatol 2006;4:1385 ) and hepatocellular carcinoma ( Chin J Cancer 2014;33:481 ) Pathophysiology[pathologyoutlines.com]
  • Pathophysiology of ascites Increased portal venous pressure ( The pathophysiology of ascites due to cirrhosis. ) Any cause of increased resistance to hepatic or portal venous blood flow can lead to ascites.[surgwiki.com]

Prevention

  • The recommendations made here are based on pathophysiology and suggest the preferred approach to diagnostic and therapeutic aspects, and preventive care.[ncbi.nlm.nih.gov]
  • Preventing Ascites Ascites can’t be prevented. However, you can lower your risk by protecting your liver with these healthy habits: Drink alcohol in moderation. This can help prevent cirrhosis (scarring of the liver). Get vaccinated for hepatitis B.[healthline.com]
  • Shell extracts of pecan nut (Carya illinoinensis), which have significant amounts of phenolic compounds in their composition, are popularly taken as tea to prevent diverse pathologies.[ncbi.nlm.nih.gov]
  • Prevention To prevent ascites, avoid the risk factors for diseases that cause this accumulation of fluid. To avoid cirrhosis, one must avoid the excessive use of alcohol.[health.ccm.net]

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Last updated: 2014-05-06 22:04