Page 3 - 02- Ascites (Cổ chướng)

– Hemoperitoneum (trauma or ectopic pregnancy)
Pathogenesis of ascites in the setting of portal hypertension (cirrhotic ascites).
– Most ascites is due to portal hypertension leading to backward transmission of increased
pressure to the visceral capillaries with subsequent dilation and shift of fluid to the
peritoneal cavity. This dilation further increases portal pressures and decreases systemic
blood volume with resultant hypotension. Systemic hypovolemia stimulates neurohormonal
mechanisms (renin angiotensin system and antidiuretic hormone) for sodium retention as an
attempt to compensate for decreased systemic volume and pressure.

RISK FACTORS
Cirrhosis—Hepatitis B & C; alcohol abuse;
Congestive heart failure (CHF); advanced kidney disease; malignancy
Tuberculosis

DIAGNOSIS

HISTORY
Address risk factors (e.g., EtOH use, tuberculosis (TB) exposure, prior malignancies, sexual
partners, transfusion history, metabolic syndrome, increased risk of nonalcoholic
steatohepatitis progressing to cirrhosis, previous history of cardiac illness).
Assess for symptoms of underlying disease (chest pain, dyspnea, orthopnea, peripheral edema,
asterixis, weight loss, night sweats, chronic cough)
Assess for complications (fever/abdominal pain might indicate spontaneous bacterial
peritonitis (SBP), progressive dyspnea due to increased abdominal girth)
Progressive abdominal distention may be painful.
PHYSICAL EXAM
Abdominal distention with flank/shifting dullness is the most sensitive (83%) and specific
(56%) exam finding; requires >1,500 mL of fluid to detect.
Signs of right-sided heart failure suggesting cardiac cirrhosis
Edema (penile/scrotal, pedal), increased jugular venous pressure.
Stigmata of chronic liver cirrhosis (palmar erythema, spider angiomata, dilated abdominal wall
collateral veins)
Other signs of advanced liver disease: jaundice, muscle wasting, gynecomastia, leukonychia,
asterixis.
Signs of underlying malignancy: cachexia; supraclavicular (Virchow) node suggests upper
abdominal malignancy.
DIFFERENTIAL DIAGNOSIS
Obesity
Large ovarian tumors
Bowel obstruction
Massive splenomegaly
DIAGNOSTIC TESTS & INTERPRETATION
Initial Tests (lab, imaging)
Ultrasound (can detect small volumes of ascitic fluid ~100 mL)