Ascites is free fluid in the peritoneal cavity; technically, it is more than 25 ml of fluid. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath (signs may be absent if fluid accumulation is < 1500 ml.)
It can result from hepatic disorders, usually chronic but sometimes acute; conditions unrelated to the liver can also cause ascites.
Hepatic causes include
- portal hypertension, usually due to cirrhosis
- chronic hepatitis
- severe alcoholic hepatitis
- hepatic vein obstruction
Nonhepatic causes include:
- generalized fluid retention associated with systemic diseases (e.g., heart failure, nephrotic syndrome, severe hypoalbuminemia, constrictive pericarditis)
- peritoneal disorders (e.g. carcinomatous or infectious peritonitis, biliary leak due to surgery or another medical procedure)
- less common causes, such as renal dialysis, pancreatitis, systemic lupus erythematosus, and endocrine disorders (e.g., myxedema)
Diagnosis is typically based on an examination together with ultrasound or a CT scan. Testing the fluid can help in determining the underlying cause.
Treatment often involves a low salt diet and diuretics (spironolactone and/or furosemide, and draining the fluid (therapeutic paracentesis). Of those with cirrhosis, more than half develop ascites in the 10 years following diagnosis.
See reference for more information.
Adapted from Tholey D. Ascites. The Merck and the Merck Manuals. Internet. Accessed on December 17, 2020.