Ascites Causes , Diagnosis and Treatment

This article is about Ascites , which is a common sign in many diseases . Definition of Ascites Excess fluid in the peritoneal cavity....

This article is about Ascites , which is a common sign in many diseases .
Definition of Ascites
Excess fluid in the peritoneal cavity. 

I. Common Causes: 
- Liver cirrhosis (80% of cases of ascites) .
- Malignant invasion of the peritoneum .
- Right ventricular failure.
II. Less Common Causes: 
A. Portal Hypertension with its causes :
1. Suprahepatic causes.           2. Intrahepatic causes. 
3. Infrahepatic causes. 

B. Peritoneal Diseases: 
- Spontaneous bacterial peritonitis .
- Tuberculous peritonitis .
- Pancreatic ascites: complicating Pancreatitis .

C. Part of Generalized Oedema:
1- Nephrotic syndrome. 2- Nephritic syndrome. 3- Nutritional oedema. 

III. Rare causes:

- Thoracic duct obstruction: ( chylous ascites). 
- Meig's Syndrome: Ovarian fibroma, ascites & right pleural effusion. 
- Hypothyroidism .( ++ Cholesterol > deposition in serous membranes .

Clinical Picture

I. Clinical Picture of Ascites
·        Symptoms:
-Abdominal discomfort & distension.
-Dyspepsia & dyspnoea.
- Development of hernia.
·        Signs :
- Inspection:
1.     Abdominal distension, mainly in the flanks,
2.     Signs of increased intra-abdominal pressure (in chronic cases):
- Widening of the subcostal angle.
- Divarication of the recti.
- Umbilicus is shifted down, everted & may be hernia.
3.      Dilated abdominal wall veins: may occur due to either: - Portal hypertension.
- IVC obstruction.
- Compression of IVC by tense ascites.
Differentiation between the 2 main types of abdominal wall veins
- Palpation:
1. Fluid thrill.
2. Liver & spleen may be felt by dipping.
3. Abdominal masses may be felt in TB & malignancy.

 - Percussion:
1. Resonance at the umbilicus & dullness in the flanks.
2. Shifting dullness from side to side.
 - Auscultation:
Venous hum may be heard in portal hypertension.

 II. Secondary Effects of Ascites :
 1. Pleural effusion on the right side may be present, due to defects in the diaphragm allowing ascitic fluid to pass into the pleura .
2. Rise of the diaphragm by ascites causes:
 - Congested neck veins.
- Dullness of the second left space. 
- Dullness at the bases of the lungs.  
- Displacement of cardiac apex up & out.
 These signs disappear when the patients sets and takes deep inspiration.
 III. Clinical Picture of the Cause :
As features of liver failure & portal hypertension in cirrhosis.  

Differential Diagnosis of Ascites

I. From Other Causes of Abdominal Enlargement:
1. Ovarian Cyst.
2. Full bladder.
3.  Pregnancy.
4. Flatulence .
5. Obesity.
II. DD of the Cause of Ascites.

1. Ultrasonography
- Will diagnose ascites and its degree.
- Will differentiate free from encysted ascites .
- May detect the cause of ascites e.g. liver cirrhosis.

2. Aspiration of ascitic fluid & its examination for:
-  Color, turbidity, specific gravity, protein content & cells. 
- Cytology for malignant cells.
- Bacteriological examination.
- Type of ascitic fluid .

Treatment of Ascites
I. Treatment of the' Cause.
II.Treatment of ascites due to cirrhosis:
• The treatment aims at improving the patient's life quality.
• One must not treat ascites if there is any evidence of encephalopathy, as treatment of ascites will deteriorate hepatic encephalopathy.
• Follow up during treatment is mandatory  :
-  Daily estimation of urine volume and body weight .
- The aim is loss of 1 kg body weight every 3 days .
- Do not permit more than lkg loss of weight/day.
- Monitoring serum Na, K and creatinine.
The measures for treatment of ascites in cirrhosis are:
1. Diet  : - Salt restriction and high protein diet.
2. Diuretics:
 - Used if weight loss is less than 1 Kg after 3 days on the diet control .
-  We use Frusemide and  spironolacton in the ratio of 40/100 .
-  If the response it not good we can increase the dose gradually up to  160 mg/day frusemide & 400 mg/day spironolacton.

3. Abdominal paracentesis:
- May be used in massive ascites.
- Remove 10 litres each time, with replacement of the proteins lost in the aspirated fluid by IV albumin .
- The patient must restrict salt in diet and he must use diuretics in order to prolong the period between aspirations .
4. Measures tojncreaseo.smotic pressure: 
 Human albumin may be used if there is marked hypoalbuminaemia.
5. Treatment of resistant ascites:
The cause for resistant ascites may be :
- Inadequate salt restriction: treated by strict regimen.
- Severe hypoalbuminaemia : treated by IV albumin. 
- Hyponatraemia: treated by fluid restriction & mannitol.
- Secondary hyperaldosteronism: treated by high dose spironolacton.
- Development of SBP or malignant ascites: treat the cause .

- If ascites is still resistant:

•  This indicates failure of the kidneys to excrete sodium.
•  It is treated by:
A. Abdominal paracentesis: with IV albumin replacement.
B. Le Veen shunt:
-  A tube with one way valve connects between peritoneal cavity & SVC, so it drains the ascitic fluid into the circulation.
-  The shunt is rarely used, as it has many complications .

6. Hepatic transplantation:

This is the best treatment if available, as it treats the cause.

7. Stem cell transplantation:

Is still in the research phase, but the results are promising.



andrology,2,Cardiology,10,Differential-diagnosis,5,E.N.T,32,General Surgery,4,General-Health,6,GIT,19,Gynecology,1,Hepatology,8,Internal-medicine,1,Microbiology,3,Orthopedics,1,Psychiatry,3,Respiratory-diseases,59,Rheumatology,50,STDs,3,Symptomatology,9,Urology,36,
Med2Date: Ascites Causes , Diagnosis and Treatment
Ascites Causes , Diagnosis and Treatment
Loaded All Posts Not found any posts VIEW ALL Readmore Reply Cancel reply Delete By Home PAGES POSTS View All RECOMMENDED FOR YOU LABEL ARCHIVE SEARCH ALL POSTS Not found any post match with your request Back Home Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sun Mon Tue Wed Thu Fri Sat January February March April May June July August September October November December Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec just now 1 minute ago $$1$$ minutes ago 1 hour ago $$1$$ hours ago Yesterday $$1$$ days ago $$1$$ weeks ago more than 5 weeks ago Followers Follow THIS CONTENT IS PREMIUM Please share to unlock Copy All Code Select All Code All codes were copied to your clipboard Can not copy the codes / texts, please press [CTRL]+[C] (or CMD+C with Mac) to copy