Page 2 - 02- Ascites (Cổ chướng)

ASCITES
Sara Elsayed, MD Ahmed Aldabdob, MD

BASICS

DESCRIPTION
Accumulation of fluid in the peritoneal cavity; may occur in conditions that cause generalized
edema
Refractory ascites; ascitic fluid that recurs after paracentesis or cannot be prevented by
treatment
Men generally have no fluid in peritoneal cavity; women may have up to 20 mL depending on
menstrual phase.

EPIDEMIOLOGY
Children: most commonly associated with nephrotic syndrome and malignancy
Adults: cirrhosis (81%), cancer (10%), heart failure (3%), other (6%)
Incidence
~50–60% of cirrhotic patients develop ascites within 10 years (1). The presence of ascites in
cirrhotic patients is a poor prognostic indicator with a survival rate of 50% at 2 years.
Prevalence
10% of patients with cirrhosis have ascites.

ETIOLOGY AND PATHOPHYSIOLOGY
Portal hypertension versus nonportal hypertension causes
– Cannot reliably establish/confirm etiology without paracentesis
– Serum-ascites albumin gradient (SAAG): (serum albumin level: ascites albumin level) helps
to differentiate causes
High portal pressure (SAAG ≥1.1)
– Cirrhosis is the most common cause of ascites in the U.S.
– Hepatitis (alcoholic, viral, autoimmune, medications)
– Acute liver failure
– Liver malignancy (primary or metastatic)
– Elevated right-sided filling pressures from heart failure or constrictive pericarditis
– Hepatic venous thrombosis (Budd-Chiari syndrome)
– Portal vein thrombosis
Normal portal pressure (SAAG <1.1)
– Peritoneal carcinomatosis
– Tuberculosis
– Severe hypoalbuminemia (nephrotic syndrome; severe enteropathy with protein loss)
– Meigs syndrome (ovarian cancer)
– Lymphatic leak (chylous ascites)
– Pancreatitis
– Inflammatory (vasculitis, lupus serositis, sarcoidosis)
– Other infections (parasitic, fungal)