Ascites

Hepaticfailure[1]

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

Ascites is the result of the following process: anatomic/foreign.

Presentation

urogenital
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  • cardiovascular
    Heart Failure
    • "Heart Failure Society of America (HFSA) 2006 Comprehensive Heart Failure Practice Guideline".[en.wikipedia.org]
    • 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]
    • Other common causes include malignancy and heart failure.[uptodate.com]
    • It is well documented that most cases are caused by a genetic predisposition to pulmonary hypertension, which progresses to congestive heart failure and terminal ascites in many cases.[merckvetmanual.com]
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  • musculoskeletal
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  • gastrointestinal
    Abdominal Pain
    • ‘Patients present with the insidious onset of ascites, abdominal pain, and fever.’[oxforddictionaries.com]
    • Abdominal pain, discomfort and difficulty breathing : These may occur when too much fluid accumulates in the abdominal cavity.[patients.gi.org]
    • Those who have spontaneous bacterial peritonitis (an infection of the peritoneum) develop abdominal pain and fever .[emedicinehealth.com]
    • This may cause difficulty breathing, especially when lying down, and abdominal pain.[study.com]
    • The fluid causes pressure on other organs in the abdominal area and may lead to: clothes feeling tighter or needing a bigger belt size bloating abdominal pain back pain difficulty sitting comfortably and moving around loss of appetite indigestion constipation[cancerresearchuk.org]
    Vomiting
    • This may cause symptoms such as vomiting , abdominal discomfort, and loss of appetite .[petmd.com]
    • Ascites causes abdominal pain, swelling, nausea, vomiting, and other difficulties.[urmc.rochester.edu]
    • Sometimes patients will experience rapid weight gain and have a distended or bloated midsection along with a lack of appetite, heartburn, nausea, and vomiting.[study.com]
    • Other symptoms often include: Shortness of breath Nausea Swelling in legs and ankles Indigestion Vomiting Heartburn Loss of appetite Infection Hernia If you have any of these symptoms, see your doctor.[webmd.com]
    • Patients with a large volume of ascites can present with abdominal distension (which may be painful), nausea, vomiting, dyspnoea and peripheral oedema 7, 9 .[radiopaedia.org]
    Nausea
    • Proper positioning may help nausea as the stomach empties toward the right and many patients are less prone to nausea when lying on their right side.[pancan.org]
    • Ascites causes abdominal pain, swelling, nausea, vomiting, and other difficulties.[urmc.rochester.edu]
    • This can cause: pain and discomfort nausea (feeling sick) indigestion and reduced appetite feeling full tiredness breathlessness.[macmillan.org.uk]
    • Sometimes patients will experience rapid weight gain and have a distended or bloated midsection along with a lack of appetite, heartburn, nausea, and vomiting.[study.com]
    • Other symptoms often include: Shortness of breath Nausea Swelling in legs and ankles Indigestion Vomiting Heartburn Loss of appetite Infection Hernia If you have any of these symptoms, see your doctor.[webmd.com]
    Abdominal Distension
    • Progressive weakness and abdominal distension.[thepoultrysite.com]
    • Clinical features Patients present with abdominal distension; fluid may be detected on physical examination with shifting dullness.[bestpractice.bmj.com]
    • Patients with a large volume of ascites can present with abdominal distension (which may be painful), nausea, vomiting, dyspnoea and peripheral oedema 7, 9 .[radiopaedia.org]
    • Symptoms Most patients who develop ascites notice abdominal distension and rapid weight gain.[patients.gi.org]
    Increased Abdominal Girth
    • 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]
    • Patients can complain of increasing abdominal girth, generalized abdominal pain and shortness of breath.[cancertherapyadvisor.com]
    • abdominal girth, early satiety, and respiratory distress depending on the amount of fluid accumulated in the abdomen.[hepatitiscentral.com]
    • As more fluid accumulates, increased abdominal girth and size are commonly seen.[medicinenet.com]
    Loss of Appetite
    • The fluid causes pressure on other organs in the abdominal area and may lead to: clothes feeling tighter or needing a bigger belt size bloating abdominal pain back pain difficulty sitting comfortably and moving around loss of appetite indigestion constipation[cancerresearchuk.org]
    • Other symptoms often include: Shortness of breath Nausea Swelling in legs and ankles Indigestion Vomiting Heartburn Loss of appetite Infection Hernia If you have any of these symptoms, see your doctor.[webmd.com]
    • This may cause symptoms such as vomiting , abdominal discomfort, and loss of appetite .[petmd.com]
    • This can cause: Rapid weight gain Loss of appetite Shortness of breath Pain in the abdomen Heartburn Development of hernias (groin, navel) It is often accompanied by swelling in the legs and ankles (edema).[dartmouth-hitchcock.org]
    Early Satiety
    • satiety, and respiratory distress depending on the amount of fluid accumulated in the abdomen.[hepatitiscentral.com]
    • If a large amount of fluid is present, the patient might complain of abdominal fullness, early satiety, abdominal pain, or shortness of breath.[clevelandclinicmeded.com]
    Peritoneal Disease
    • Peritoneal diseases including infectious peritonitis and malignancies can also cause ascites.[bestpractice.bmj.com]
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  • respiratoric
    Pleural Effusion
    • CXR may show pleural effusion, evidence of pulmonary metastases or heart failure.[patient.info]
    • The accumulation of fluid may cause breathing difficulties by compressing the diaphragm or forming a pleural effusion .[medicinenet.com]
    • Pleural effusion and hydrothorax can also occur (below).[sisbib.unmsm.edu.pe]
    Dyspnea
    • Symptoms and Types Lethargy Anorexia Vomiting Weight gain Weakness at times Signs of discomfort when the abdomen is felt Groaning noises when lying down Difficulty breathing (or dyspnea ) may also occur due to abdominal swelling putting pressure on the[petmd.com]
    • 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]
    • 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.[henriettes-herb.com]
    • Treatment of ascites can dramatically improve quality of life by decreasing abdominal discomfort or dyspnea, or both.[clevelandclinicmeded.com]
    Orthopnea
    • The shortness of breath tends to be worse with activity and with lying flat (orthopnea).[emedicinehealth.com]
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  • Entire body system
    Weight Gain
    • A 57-year-old woman presents with an adnexal mass and recent weight gain but otherwise feels well.[jamaevidence.mhmedical.com]
    • Try to avoid drinking excess water, which can lead to additional swelling and weight gain.[belmarrahealth.com]
    • Intake of more water during the case of ascites adds to swelling and weight gain.[organicfacts.net]
    • Nevertheless, Packed Cell Volume, weight gain and feed efficiency were not affected by the treatment ( Table 1 ).[scielo.br]
    • Sometimes patients will experience rapid weight gain and have a distended or bloated midsection along with a lack of appetite, heartburn, nausea, and vomiting.[study.com]
    Whipple Disease
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  • Workup

    Pathology

    Biopsy
    Hepatocellular Carcinoma
    • There are a wide variety of causing liver tissue damaged such as alcoholic cirrhosis, hepatitis, non-alcoholic fatty liver disease (NAFLD), hepatocellular carcinoma to name a few.[alfapump.com]
    • Up to 19 percent of patients with cirrhosis will have hemorrhagic ascites, which may develop spontaneously (72 percent probably due to bloody lymph and 13 percent due to hepatocellular carcinoma) or following paracentesis [ 5 ].[uptodate.com]
    • High serum hepatitis B viral levels are associated with an increased risk of progression to cirrhosis and hepatocellular carcinoma; experts and guidelines have endorsed maximal HBV viral suppression with antiviral therapy to reduce this risk.[depts.washington.edu]
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  • Laboratory

    Pleura
    Pleural Effusion
    • CXR may show pleural effusion, evidence of pulmonary metastases or heart failure.[patient.info]
    • The accumulation of fluid may cause breathing difficulties by compressing the diaphragm or forming a pleural effusion .[medicinenet.com]
    • Pleural effusion and hydrothorax can also occur (below).[sisbib.unmsm.edu.pe]
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  • Imaging

    X-ray
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  • Treatment

    Prognosis

    Complications

    Portal Vein Thrombosis
    • Flow to the umbilicus (rare, in portal vein thrombosis).[stanfordmedicine25.stanford.edu]
    • Aetiology Causes of transudative ascites: hepatic cirrhosis alcoholic hepatitis heart failure (CCF) hypoproteinaemia portal vein thrombosis peritoneal dialysis malignancy ( 10% of refractory ascites) 7, 9 most commonly: breast, ovarian , endometrial,[radiopaedia.org]
    • Vein Thrombosis Veno-Occlusive Disease Myxedema Fatty Liver of Pregnancy Peritoneal Carcinomatosis Tuberculous Peritonitis Pancreatic Ascites Bowel Obstruction Biliary Ascites Nephrotic Syndrome Posteroperative Lymphatic Leak Serositis in Connective[lifeinthefastlane.com]
    • vein thrombosis Congestive heart failure Acute renal failure Active encephalopathy Alcoholic hepatitis Pregnancy Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff[clinicaltrials.gov]
    • Other conditions that can cause this problem include: Clots in the veins of the liver (portal vein thrombosis) Congestive heart failure Pancreatitis Thickening and scarring of the sac-like covering of the heart Kidney dialysis may also be linked to ascites[nlm.nih.gov]
    Budd-Chiari Syndrome
    • Budd-Chiari Syndrome Neoplasm, Local Coagulopathy Neoplastic association Collagen Vascular Disease - eg.[enotes.tripod.com]
    • Other causes Causes of portal hypertension other than cirrhosis include congestive heart failure, constrictive pericarditis, alcoholic hepatitis, fulminant hepatitis, subacute hepatitis, massive liver metastasis, and Budd-Chiari syndrome, which may be[bestpractice.bmj.com]
    • The concept surrounds oncotic-hydrostatic balance Simple calculation: Serum albumin – Ascites albumin SAAG SAAG 1.1 mg/dl SAAG 1.1 mg/d Cirrhosis Alcoholic Hepatitis Cardiac Ascites “Mixed Ascites” Massive Liver Metastasis Fulminant Hepatic Failure Budd-Chiari[lifeinthefastlane.com]
    • Causes and risk factors of ascites Causes and risk factors of ascites are largely in part due to liver conditions, including: Cirrhosis Acute liver failure Budd-Chiari syndrome Liver cancer Hepatitis B or C Other causes include: Heart failure Nephritic[belmarrahealth.com]
    • 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 (thrombosis of the hepatic vein) and portal vein thrombosis .[en.wikipedia.org]
    Proteinuria
    • HRS is established in a patient with a creatinine of 1.5mg/dl that does not improve with withdrawal of diuretics, volume expansion with albumin, absence of obstructive or parenchymal renal disease (indicated by ultrasonography, proteinuria), and absence[clevelandclinicmeded.com]
    Acute Pancreatitis
    • Pancreatic ascites can also be caused by acute pancreatitis as well as trauma to the pancreas.[medicinenet.com]
    Hypokalemia
    • Additional symptoms will help determine further diagnostic procedures. hypokalemia Lower levels of potassium in the blood than normal pleural effusion A process in which fluid accumulates in the space between the layers of pleura scrotum The sac that[petmd.com]
    • In the event of marked hyponatremia, hyperkalemia or hypokalemia, renal insufficiency, dehydration, or encephalopathy, diuretics should be reduced or discontinued.[clevelandclinicmeded.com]
    Hepatitis
    • Patients with chronic hepatitis B infection who have negative hepatitis B e antigen are not always by definition “healthy carriers.”[depts.washington.edu]
    • "Compartmentalization of ascites and edema in patients with hepatic cirrhosis".[en.wikipedia.org]
    • The Hepatitis C Help Book .[liversupport.com]
    • Transudative (Serum Albumin - Ascites Albumin 1.1gm/dl) Heart Failure Group Alcoholic Liver Disease (Micronodular Cirrhosis, Alcoholic Hepatitis) Hepatic Necrosis Hepatic Vein Thrombosis (Budd-Chiari Syndrome) or IVC Obstruction Portal Vein Occlusion[enotes.tripod.com]
    Peritonitis
    Hepatocellular Carcinoma
    • There are a wide variety of causing liver tissue damaged such as alcoholic cirrhosis, hepatitis, non-alcoholic fatty liver disease (NAFLD), hepatocellular carcinoma to name a few.[alfapump.com]
    • Up to 19 percent of patients with cirrhosis will have hemorrhagic ascites, which may develop spontaneously (72 percent probably due to bloody lymph and 13 percent due to hepatocellular carcinoma) or following paracentesis [ 5 ].[uptodate.com]
    • High serum hepatitis B viral levels are associated with an increased risk of progression to cirrhosis and hepatocellular carcinoma; experts and guidelines have endorsed maximal HBV viral suppression with antiviral therapy to reduce this risk.[depts.washington.edu]
    Liver Failure
    • Many other symptoms of liver failure may also be present.[nlm.nih.gov]
    • It’s often a sign of liver failure and occurs most often with cirrhosis .[webmd.com]
    • failure Portal vein thrombosis Congestive heart failure Acute renal failure Active encephalopathy Alcoholic hepatitis Pregnancy Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study[clinicaltrials.gov]
    Alcoholic Hepatitis
    • hepatitis ( ICD-10-CM Diagnosis Code K70.11 Alcoholic hepatitis with ascites 2016 2017 2018 Billable/Specific Code Adult Dx (15-124 years) K70.11 ) ascites in toxic liver disease with chronic active hepatitis ( ICD-10-CM Diagnosis Code K71.51 Toxic liver[icd10data.com]
    • Albumin serum-ascites gradient serum albumin - ascitic albumin - Gradient of 1.1 g/dL suggests portal hypertension; seen in cirrhosis, alcoholic hepatitis, CHF, massive liver metastasis, fulminant liver failure, portal-veiin thrombosis, Budd-Chiari synd[enotes.tripod.com]
    • Other causes Causes of portal hypertension other than cirrhosis include congestive heart failure, constrictive pericarditis, alcoholic hepatitis, fulminant hepatitis, subacute hepatitis, massive liver metastasis, and Budd-Chiari syndrome, which may be[bestpractice.bmj.com]
    • Aetiology Causes of transudative ascites: hepatic cirrhosis alcoholic hepatitis heart failure (CCF) hypoproteinaemia portal vein thrombosis peritoneal dialysis malignancy ( 10% of refractory ascites) 7, 9 most commonly: breast, ovarian , endometrial,[radiopaedia.org]
    • Serum-Ascites Albumin Gradient (SAAG) The SAAG has become more favored in helping to characterize ascites fluid The concept surrounds oncotic-hydrostatic balance Simple calculation: Serum albumin – Ascites albumin SAAG SAAG 1.1 mg/dl SAAG 1.1 mg/d Cirrhosis Alcoholic[lifeinthefastlane.com]
    Tuberculosis
    • – 2% or spontaneous bacterial peritonitis Pancreatitis – 1% Serositis Nephrotic syndrome [6] Hereditary angioedema [7] Other rare causes: Meigs syndrome Vasculitis Hypothyroidism Renal dialysis Peritoneum mesothelioma Abdominal tuberculosis Mastocytosis[en.wikipedia.org]
    • When mononuclear cells predominated , tuberculosis or fungal infection is likely.[hepatitiscentral.com]
    • (See "Diagnostic and therapeutic abdominal paracentesis" and "Malignancy-related ascites" and "Chylous, bloody, and pancreatic ascites" and "Abdominal tuberculosis" and "Ascites in adults with cirrhosis: Initial therapy" and "Ascites in adults with cirrhosis[uptodate.com]
    • Some of these conditions include various cancers, heart failure, kidney failure, infections of the pancreas, or tuberculosis.[study.com]
    • […] peritoneal dialysis malignancy ( 10% of refractory ascites) 7, 9 most commonly: breast, ovarian , endometrial, gastrointestinal and pancreatic 7 Causes of exudative ascites: peritoneal carcinomatosis pancreatitis abscess nephrotic syndrome peritonitis , e.g. tuberculosis[radiopaedia.org]
    Portal Hypertension
    Nephrotic Syndrome
    • When clinically detectable, ascites may indicate underlying heart failure, liver disease, nephrotic syndrome, or malignancy.[jamaevidence.mhmedical.com]
    • Syndrome Serositis Bowel obstruction or infarction Treatment Monitoring The treatment of ascites depends on it’s cause.[hepatitiscentral.com]
    • Due to infections Nephrotic syndrome Meig's ovarian tumor syndrome Constrictive pericarditis Inferior vena cava obstruction Viral hepatitis with submassive or massive hepatic necrosis B.[enotes.tripod.com]
    • Conditions causing hypo-albuminemia such as nephrotic syndrome and protein-losing enteropathy may result in ascites.[bestpractice.bmj.com]
    • syndrome peritonitis , e.g. tuberculosis ischaemic bowel bowel obstruction Plain radiograph Detection of intraperitoneal fluid on a plain radiograph requires at least 500 mL to be present.[radiopaedia.org]
    Edema
    • […] of larynx ( J38.4 ) edema of nasopharynx ( J39.2 ) edema of pharynx ( J39.2 ) gestational edema ( O12.0- ) hereditary edema ( Q82.0 ) hydrops fetalis NOS ( P83.2 ) hydrothorax ( J94.8 ) hydrops fetalis NOS ( P83.2 ) newborn edema ( P83.3 ) pulmonary[icd10data.com]
    • In addition to ascites, the extra fluid can be appreciated in many other areas of the body as edema (swelling).[emedicinehealth.com]
    • Causes There are many causes for the occurrence of fluid buildup (or edema ) in the abdomen.[petmd.com]
    • If the ascites is due to heart failure , there may be shortness of breath as well as leg swelling (edema).[emedicinehealth.com]
    • "Compartmentalization of ascites and edema in patients with hepatic cirrhosis".[en.wikipedia.org]
    Whipple Disease
    Hemochromatosis
    • Serum Albumin - Ascites Albumin 1.1gm/dl) Heart Failure Group Alcoholic Liver Disease (Micronodular Cirrhosis, Alcoholic Hepatitis) Hepatic Necrosis Hepatic Vein Thrombosis (Budd-Chiari Syndrome) or IVC Obstruction Portal Vein Occlusion Meig's Syndrome Hemochromatosis[enotes.tripod.com]
    Viral Hepatitis
    • Due to infections Nephrotic syndrome Meig's ovarian tumor syndrome Constrictive pericarditis Inferior vena cava obstruction Viral hepatitis with submassive or massive hepatic necrosis B.[enotes.tripod.com]
    • Cirrhosis is a liver disorder caused by excessive alcohol consumption or viral hepatitis that can result in ascites, though there are other conditions that can also lead to ascites.[study.com]
    • The medical history may provide clues to the underlying cause and typically includes questions about previous diagnosis of liver disease, viral hepatitis infection and its risk factors, alcohol abuse, family history of liver disease, heart failure, cancer[medicinenet.com]
    Umbilical Hernia
    • Only patients with clinically tense symptomatic ascites (shortness of breath, umbilical hernia, abdominal pain and/or distension, and/or limitation of activity) who have either diuretic-resistant ascites or diuretic-intractable ascites are being studied[clinicaltrials.gov]
    • The high intra-abdominal pressure may push out an umbilical hernia or even an inguinal hernia.[patient.info]
    Right-Sided Heart Failure
    • Portal hypertension is usually caused by liver cirrhosis or, less commonly, outflow obstruction from right-sided heart failure or Budd-Chiari syndrome.[clevelandclinicmeded.com]
    Hepatitis B
    • Patients with chronic hepatitis B infection who have negative hepatitis B e antigen are not always by definition “healthy carriers.”[depts.washington.edu]
    • Causes and risk factors of ascites Causes and risk factors of ascites are largely in part due to liver conditions, including: Cirrhosis Acute liver failure Budd-Chiari syndrome Liver cancer Hepatitis B or C Other causes include: Heart failure Nephritic[belmarrahealth.com]
    • Get vaccinated for hepatitis B.[healthline.com]
    • B, and pneumococcal pneumonia Talk to your doctor about all medicines you take, including herbs and supplements and over-the-counter medicines Procedures that you may have are: Inserting a needle into the belly to remove large volumes of fluid (called[nlm.nih.gov]
    Hepatorenal Syndrome
    • (February 2017) Hepatorenal syndrome [ edit ] This section is empty.[en.wikipedia.org]
    • Complications may include: Spontaneous bacterial peritonitis (a life-threatening infection of the ascites fluid) Hepatorenal syndrome (kidney failure) Weight loss and protein malnutrition Mental confusion, change in the level of alertness, or coma (hepatic[nlm.nih.gov]
    • Lenz K, Buder R, Kapun L, et al ; Treatment and management of ascites and hepatorenal syndrome: an update.[patient.info]
    • EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.[psnet.ahrq.gov]
    Spontaneous Bacterial Peritonitis
    • Complications [ edit ] Spontaneous bacterial peritonitis [ edit ] This section is empty.[en.wikipedia.org]
    • ‘Patients who have cirrhosis with ascites are prone to spontaneous bacterial peritonitis.’[oxforddictionaries.com]
    • Ascites and spontaneous bacterial peritonitis.[nlm.nih.gov]
    • Common pitfalls in managing ascites Diagnosing spontaneous bacterial peritonitis.[psnet.ahrq.gov]
    Wilson Disease
    • Causes of Ascites Ascites can be caused by a number of conditions including: * Alcoholism with cirrhosis * Hepatitis * Cancer of the liver * Wilson’s disease * Cystic fibrosis * Blood clots in the portal vein * Pancreatitis * Kidney disease * Congestive[alcoholrehab.com]
    Kidney Disease
    • Diseases (NIDDK) Keywords provided by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): refractory ascites paracenteses Additional relevant MeSH terms: Liver Cirrhosis Ascites Liver Diseases Digestive System Diseases Pathologic[clinicaltrials.gov]
    • Ascites can also be caused by cancer, heart failure, kidney disease, or pancreatic disease.[dartmouth-hitchcock.org]
    • Causes of Ascites Ascites can be caused by a number of conditions including: * Alcoholism with cirrhosis * Hepatitis * Cancer of the liver * Wilson’s disease * Cystic fibrosis * Blood clots in the portal vein * Pancreatitis * Kidney disease * Congestive[alcoholrehab.com]
    • Other potential risk factors are related to the other underlying conditions, such as congestive heart failure, malignancy , and kidney disease .[medicinenet.com]
    Nonalcoholic Steatohepatitis
    • Vuppalanchi R, Chalasani N ; Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management.[patient.info]

    Etiology

    Causes

    Hypokalemia
    • Additional symptoms will help determine further diagnostic procedures. hypokalemia Lower levels of potassium in the blood than normal pleural effusion A process in which fluid accumulates in the space between the layers of pleura scrotum The sac that[petmd.com]
    • In the event of marked hyponatremia, hyperkalemia or hypokalemia, renal insufficiency, dehydration, or encephalopathy, diuretics should be reduced or discontinued.[clevelandclinicmeded.com]
    Hemochromatosis
    • Serum Albumin - Ascites Albumin 1.1gm/dl) Heart Failure Group Alcoholic Liver Disease (Micronodular Cirrhosis, Alcoholic Hepatitis) Hepatic Necrosis Hepatic Vein Thrombosis (Budd-Chiari Syndrome) or IVC Obstruction Portal Vein Occlusion Meig's Syndrome Hemochromatosis[enotes.tripod.com]
    Liver Cirrhosis
    • Condition or disease Intervention/treatment Phase Ascites Liver Cirrhosis Procedure: Transjugular intrahepatic portasystemic shunts (TIPS) Procedure: Total paracentecis (TP) Phase 3 Study Type : Interventional (Clinical Trial) Allocation: Randomized Masking[clinicaltrials.gov]
    • When a liver cirrhosis patient is suffering from thrombosis, it is not possible to perform a liver transplant, unless the thrombosis is very minor.[en.wikipedia.org]
    • ‘Signs and symptoms are primarily those of liver cirrhosis and ascites.’[oxforddictionaries.com]
    • The chief factor contributing to ascites in liver cirrhosis is portal hypertension .[link.springer.com]
    Wilson Disease
    • Causes of Ascites Ascites can be caused by a number of conditions including: * Alcoholism with cirrhosis * Hepatitis * Cancer of the liver * Wilson’s disease * Cystic fibrosis * Blood clots in the portal vein * Pancreatitis * Kidney disease * Congestive[alcoholrehab.com]

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Other symptoms

    Meigs Syndrome
    • Syndrome, Struma ovarii) B.[enotes.tripod.com]
    • Bacterial peritonitis Malignant disease of the peritoneum D) Leakage of fluid into the peritoneal cavity Bile ascites Pancreatic ascites(secondary to a leaking pseudocyst) Chylous ascites Urine ascites E) Miscellaneous causes Myxedema Ovarian disease(Meigs[hepatitiscentral.com]
    • Carcinoma of ovary: Meigs' syndrome is a rare complication of ovarian cancer and produces ascites out of all proportion to the size of the tumour and pleural effusions, often unilateral.[patient.info]
    • SAAG ("exudate") are: Cancer (metastasis and primary peritoneal carcinomatosis ) – 10% Infection: Tuberculosis – 2% or spontaneous bacterial peritonitis Pancreatitis – 1% Serositis Nephrotic syndrome [6] Hereditary angioedema [7] Other rare causes: Meigs[en.wikipedia.org]
    Alcoholic Liver Disease
    • This is the final stage of alcoholic liver disease and it means that the liver had been damaged beyond its ability to repair itself.[alcoholrehab.com]
    • The mainstay to managing patients with ascites is modest salt restriction, treatment with diuretic therapy, and cessation of alcohol in patients with alcoholic liver disease.[psnet.ahrq.gov]
    • Transudative (Serum Albumin - Ascites Albumin 1.1gm/dl) Heart Failure Group Alcoholic Liver Disease (Micronodular Cirrhosis, Alcoholic Hepatitis) Hepatic Necrosis Hepatic Vein Thrombosis (Budd-Chiari Syndrome) or IVC Obstruction Portal Vein Occlusion[enotes.tripod.com]
    Hereditary Angioedema

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    References

    • Acute peritonitis: a rare presentation of chylous ascites - A Lamblin, E Mulliez, L Lemaitre, F Pattou - Annales de , 2003 - ingentaconnect.com
    • Chylous ascites following abdominal aortic aneurysmectomy. Management with total parenteral hyperalimentation. - AH Meinke - Annals of surgery, 1979 - ncbi.nlm.nih.gov
    • Cerebrospinal fluid ascites: a complication of a ventriculoperitoneal shunt - DF Dean, IB Keller - Journal of Neurology, Neurosurgery & Psychiatry, 1972 - jnnp.bmj.com
    • Acute portal vein thrombosis unrelated to cirrhosis: A prospective multicenter follow‐up study - A Plessier, S Darwish‐Murad - , 2009 - Wiley Online Library
    • Cutaneous and soft-tissue manifestations of sepsis due to gram-negative enteric bacilli - DM Musher - Review of Infectious Diseases, 1980 - cid.oxfordjournals.org
    • Cancer antigen 125 in patients with chronic liver disease - H Devarbhavi, D Kaese, AW Williams, J Rakela - Mayo Clinic , 2002 - Elsevier
    • Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis. - MA Piras, C Gakis, M Budroni, G Andreoni - British medical journal, 1978 - bmj.com
    • Ascites and right pleural effusion: demonstration of a peritoneo-pleural communication - J Verreault, S Lepage, G Bisson, A Plante - J Nucl Med, 1986 - ukpmc.ac.uk
    • Acetazolamide and Chlorothiazide in the Treatment of Ascites Due to Cirrhosis of the Liver - RM Myerson, RE Stout, AL Forte - New England Journal of , 1959 - Mass Medical Soc
    • Acute renal failure in patients with cirrhosis: perspectives in the age of MELD - R Moreau, D Lebrec - Hepatology, 2003 - Wiley Online Library
    • Acute fatty liver of pregnancy with hepatic coma and Mallory-Weiss Syndrome: report of a case - PA Douvres, WS Rosenthal, P Metzger - Digestive Diseases and , 1965 - Springer
    • Of angiotensin II and norepinephrine and blood pressure, electrolyte balance, and aldosterone and cortisol secretion in normal man and in cirrhosis with ascites - RP Ames, AJ Borkowski, AM Sicinski - Journal of Clinical , 1965 - ncbi.nlm.nih.gov
    • Alterations in thoracic duct lymph flow in hepatic cirrhosis: significance in portal hypertension - AE Dumont, JH Mulholland - Annals of surgery, 1962 - ncbi.nlm.nih.gov
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    • Cardiac tamponade in medical patients - BA Guberman, NO Fowler, PJ Engel, M Gueron - Circulation, 1981 - Am Heart Assoc
    • Abdominal wall hernias in the setting of cirrhosis - J Belghiti, F Durand - Seminars in liver disease, 2008 - thieme-connect.com
    • Cell-free transmission in adult Swiss mice of a disease having the character of a leukemia - C Friend - The Journal of experimental medicine, 1957 - jem.rupress.org
    • Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo - T Mutoh, WJ Lamm, LJ Embree - Journal of Applied , 1991 - Am Physiological Soc
    • ABC of heart failure: clinical features and complications - RDS Watson, CR Gibbs, GYH Lip - BMJ: British Medical Journal, 2000 - ncbi.nlm.nih.gov
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    • A Systematic Approach to X-Ray Analysis - K Malagari - Diseases of the Heart, Chest & Breast, 2007 - Springer
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