Question 1 of 10

    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

    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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  • respiratoric
    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]
    • Treatment of ascites can dramatically improve quality of life by decreasing abdominal discomfort or dyspnea, or both.[clevelandclinicmeded.com]
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  • gastrointestinal
    Abdominal Distension
    • Progressive weakness and abdominal distension.[thepoultrysite.com]
    • distension; fluid may be detected on physical examination with shifting dullness.[bestpractice.bmj.com]
    • Patients with 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]
    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]
    • It usually causes fever and abdominal pain.[my.clevelandclinic.org]
    • At 35 weeks of gestation, the patient started having vaginal bleeding and mild abdominal pain.[hindawi.com]
    • This may cause difficulty breathing, especially when lying down, and abdominal pain.[study.com]
    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]
    • The onset and progression of ascites is associated with poor prognosis and deterioration in the quality of life of patients, as ascites can cause debilitating symptoms such as abdominal pain, early satiety and compromised respiratory, gastrointestinal[frontiersin.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
    • 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]
    • 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]
    • 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]
    • The swollen abdomen puts pressure on the stomach, sometimes leading to loss of appetite, and pressure on the lungs, sometimes leading to shortness of breath.[msdmanuals.com]
    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]
    Peritoneal Disease
    • Peritoneal diseases including infectious peritonitis and malignancies can also cause ascites.[bestpractice.bmj.com]
    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]
    • […] disease Uncommonly found in hypothyroidism History of alcohol use Tuberculosis Symptoms of ascites Symptoms of ascites include: Sudden weight gain Swollen abdomen Difficulty breathing when lying down Diminished appetite Abdominal pain Bloating Nausea and vomiting[belmarrahealth.com]
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  • musculoskeletal
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  • cardiovascular
    Heart Failure
    • Ascitic fluid can have many sources such as liver disease , cancers , congestive heart failure , or kidney failure .[medicinenet.com]
    • The most common cause is cirrhosis, accounting for approximately 75% to 80% of cases. [1] [2] Other causes include malignancy (10%), heart failure (3%), tuberculosis (2%), pancreatitis (1%), and other rare conditions. [2] Clinical features Patients present[bestpractice.bmj.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]
    • Other common causes include malignancy and heart failure.[uptodate.com]
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  • urogenital
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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]
    • The usual causes are: Malignancies of the gastrointestinal tract (carcinoma of stomach, colon, pancreas; primary hepatocellular carcinoma and metastatic liver cancer).[patient.info]
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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

    Acute Pancreatitis
    • Pancreatic ascites can also be caused by acute pancreatitis as well as trauma to the pancreas.[medicinenet.com]
    Alcoholic Hepatitis
    • […] shunting of blood to the systemic circulation. [4] About 50% of patients with cirrhosis develop ascites within 10 years. [3] [5] Other causes Causes of portal hypertension other than cirrhosis include congestive heart failure, constrictive pericarditis, alcoholic[bestpractice.bmj.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]
    • hepatitis Pregnancy Choosing to participate in a study is an important personal decision.[clinicaltrials.gov]
    • 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]
    Budd-Chiari Syndrome
    • Although most commonly due to cirrhosis, severe liver disease or metastatic cancer, its presence can be a sign of other significant medical problems, such as BuddChiari syndrome.[en.wikipedia.org]
    • Budd-Chiari Syndrome Neoplasm, Local Coagulopathy Neoplastic association Collagen Vascular Disease - eg.[enotes.tripod.com]
    • […] ascites within 10 years. [3] [5] 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[bestpractice.bmj.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]
    • 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]
    Edema
    • Causes There are many causes for the occurrence of fluid buildup (or edema ) in the abdomen.[petmd.com]
    • The goal is weight loss of no more than 1.0 kg/day for patients with both ascites and peripheral edema and no more than 0.5 kg/day for patients with ascites alone.[en.wikipedia.org]
    • 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]
    • April 20, 1998. . ascites [ ah-si tēz ] abnormal accumulation of serous fluid ( edema ) within the peritoneal cavity .[medical-dictionary.thefreedictionary.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]
    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]
    Hepatitis
    • Patients with chronic hepatitis B infection who have negative hepatitis B e antigen are not always by definition “healthy carriers.”[depts.washington.edu]
    • The Hepatitis C Help Book .[liversupport.com]
    • Complications involve portal vein thrombosis and splenic vein thrombosis: clotting of blood affects the hepatic portal vein or varices associated with splenic vein.[en.wikipedia.org]
    • 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]
    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]
    • These include hepatitis B, hepatitis C, and alcoholism/alcohol abuse.[my.clevelandclinic.org]
    • 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
    • This condition is called hepatorenal syndrome.[my.clevelandclinic.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]
    • EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.[psnet.ahrq.gov]
    • Lenz K, Buder R, Kapun L, et al ; Treatment and management of ascites and hepatorenal syndrome: an update.[patient.info]
    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]
    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]
    • These include liver disease, blood clots, kidney disease, or heart failure.[cancer.net]
    • Ascites can also be caused by cancer, heart failure, kidney disease, or pancreatic disease.[dartmouth-hitchcock.org]
    • Other potential risk factors are related to the other underlying conditions, such as congestive heart failure, malignancy , and kidney disease .[medicinenet.com]
    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 Choosing to participate in a study is an important personal decision.[clinicaltrials.gov]
    Nephrotic Syndrome
    • When clinically detectable, ascites may indicate underlying heart failure, liver disease, nephrotic syndrome, or malignancy.[jamaevidence.mhmedical.com]
    • Conditions causing hypo-albuminaemia such as nephrotic syndrome and protein-losing enteropathy may result in ascites.[bestpractice.bmj.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]
    • 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]
    Nonalcoholic Steatohepatitis
    • Vuppalanchi R, Chalasani N ; Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management.[patient.info]
    Peritonitis
    Portal Hypertension
    • Although the sequence of events that occurs between the development of portal hypertension and renal sodium retention is not entirely clear, portal hypertension apparently leads to an increase in nitric oxide levels.[emedicine.medscape.com]
    • This can lead to portal hypertension and reduction in blood flow.[en.wikipedia.org]
    • Causes include diseases that lead to portal hypertension, hypoalbuminemia, and neoplasms.[bestpractice.bmj.com]
    • […] patients with extensive hepatic metastases resulting in portal hypertension.[cancertherapyadvisor.com]
    • It most commonly results from Portal hypertension —high blood pressure in the portal vein (the large vein that brings blood from the intestine to the liver) and its branches Portal hypertension usually results from cirrhosis (severe scarring of the liver[msdmanuals.com]
    Portal Vein Thrombosis
    • Complications involve portal vein thrombosis and splenic vein thrombosis: clotting of blood affects the hepatic portal vein or varices associated with splenic vein.[en.wikipedia.org]
    • Flow to the umbilicus (rare, in portal vein thrombosis).[stanfordmedicine25.stanford.edu]
    • vein thrombosis Congestive heart failure Acute renal failure Active encephalopathy Alcoholic hepatitis Pregnancy Choosing to participate in a study is an important personal decision.[clinicaltrials.gov]
    • 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]
    Preeclampsia
    • She was observed for signs of severe preeclampsia.[hindawi.com]
    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]
    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]
    Spontaneous Bacterial Peritonitis
    • If spontaneous bacterial peritonitis is diagnosed, people are given antibiotics such as cefotaxime .[msdmanuals.com]
    • ‘Patients who have cirrhosis with ascites are prone to spontaneous bacterial peritonitis.’[oxforddictionaries.com]
    • When this happens, the condition is called spontaneous bacterial peritonitis.[my.clevelandclinic.org]
    • Ascites and spontaneous bacterial peritonitis.[nlm.nih.gov]
    Tuberculosis
    • When mononuclear cells predominated , tuberculosis or fungal infection is likely.[hepatitiscentral.com]
    • – 2% or spontaneous bacterial peritonitis Pancreatitis – 1% Serositis Nephrotic syndrome Hereditary angioedema Other rare causes: Meigs syndrome Vasculitis Hypothyroidism Renal dialysis Peritoneum mesothelioma Abdominal tuberculosis Routine complete[en.wikipedia.org]
    • The most common cause is cirrhosis, accounting for approximately 75% to 80% of cases. [1] [2] Other causes include malignancy (10%), heart failure (3%), tuberculosis (2%), pancreatitis (1%), and other rare conditions. [2] Clinical features Patients present[bestpractice.bmj.com]
    • Some of these conditions include various cancers, heart failure, kidney failure, infections of the pancreas, or tuberculosis.[study.com]
    • Acute liver failure Budd-Chiari syndrome Liver cancer Hepatitis B or C Other causes include: Heart failure Nephritic syndrome Pancreas disorders Direct irritation of the peritoneum Ovary disease Uncommonly found in hypothyroidism History of alcohol use Tuberculosis[belmarrahealth.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]
    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]
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  • Etiology

    Epidemiology

    Sex distribution
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    Pathophysiology

    Prevention

    Summary

    Patient Information

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    References

    • Drainage of ascites as an alternative to abdominal paracentesis in patients with severe ovarian hyperstimulation syndrome, obesity, and generalized edema - A Raziel, S Friedler, M Schachter, D Strassburger - Fertility and sterility, 1998 - Elsevier
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