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The Medical Clinics of North America Jul 2009Ascites is the pathologic accumulation of fluid in the peritoneal cavity and is a common manifestation of liver failure, being one of the cardinal signs of portal... (Review)
Review
Ascites is the pathologic accumulation of fluid in the peritoneal cavity and is a common manifestation of liver failure, being one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves an assessment of its cause by determining the serum-ascites albumin gradient and the exclusion of complications eg, spontaneous bacterial peritonitis. Although sodium restriction and diuretics remain the cornerstone of ascites management, many patients require additional therapy when they become refractory to such medical treatment. These include repeated large volume paracentesis and transjugular intrahepatic portosystemic shunts. This review article summarizes diagnostic tools and provides an evidence-based approach to the management of ascites.
Topics: Ascites; Ascitic Fluid; Cardiac Output; Diet, Sodium-Restricted; Disease Progression; Diuretics; Drug Therapy, Combination; Furosemide; Humans; Hypertension, Portal; Liver Cirrhosis; Paracentesis; Peritoneovenous Shunt; Peritonitis; Portasystemic Shunt, Transjugular Intrahepatic; Prognosis; Spironolactone; Splanchnic Circulation; Vasodilation
PubMed: 19577115
DOI: 10.1016/j.mcna.2009.03.007 -
Indian Journal of Pediatrics Nov 2016Ascites is an accumulation of serous fluid within the peritoneal cavity. It is the most common complication of liver cirrhosis. In children, hepatic, renal and cardiac... (Review)
Review
Ascites is an accumulation of serous fluid within the peritoneal cavity. It is the most common complication of liver cirrhosis. In children, hepatic, renal and cardiac disorders are the most common causes. Portal hypertension and sodium and fluid retention are key factors in the pathophysiology of ascites. Peripheral arterial vasodilatation hypothesis is the most accepted mechanism for inappropriate sodium retention and formation of ascites. Diagnostic paracentesis is indicated in children with newly diagnosed ascites and in children with suspected complications of ascites. Ascitic fluid is evaluated for cell count, protein level, and culture. The serum-ascites albumin gradient (SAAG) is the best single test for classifying ascites into portal hypertensive (SAAG >1.1 g/dl) and non-portal hypertensive (SAAG <1.1 g/dl). A neutrophil count ≥250 cells/mm is highly suggestive of bacterial peritonitis. The treatment of ascites due to non-liver disease depends on the underlying condition. In liver disease, diuretics as monotherapy or dual therapy and salt restriction form the mainstay of treatment in children with mild to moderate ascites. Fluid restriction is helpful in children with hyponatremia. In non-responsive ascites or in children with large ascites, large volume paracentesis (LVP) with albumin infusion should be performed. In children with refractory ascites, LVP with albumin administration, transjugular intrahepatic porto-systemic shunt (TIPS), peritoneo-venous shunting and liver transplantation are other therapeutic modalities that need to be considered.
Topics: Ascites; Ascitic Fluid; Child; Humans; Hypertension, Portal; Liver Cirrhosis; Paracentesis; Peritonitis
PubMed: 27278239
DOI: 10.1007/s12098-016-2168-1 -
Emergency Medicine Clinics of North... Aug 1989In summary, the diagnosis of ascites should be considered in all patients presenting with abdominal distention. A careful history and physical examination should be... (Review)
Review
In summary, the diagnosis of ascites should be considered in all patients presenting with abdominal distention. A careful history and physical examination should be performed to rule out conditions that mimic ascites. Ultrasonography should be performed in questionable cases of ascites since physical examination and radiographic signs of ascites are unreliable. Paracentesis can help determine the etiology. Ascitic fluid should be examined to rule out spontaneous bacterial peritonitis, one of the few curable complications of cirrhosis. An ascitic fluid PMN count of greater than 250 per mm3 proves a sensitive indicator of infection. Medical treatment of cirrhotic ascites includes dietary sodium restriction and diuretics++. Large-volume paracentesis, with or without the use of colloid infusions, may provide useful adjunctive therapy. In rare instances, intractable ascites may be treated with a peritoneovenous shunt, although the complications and mortality rate of this procedure are significant. Peritoneovenous shunting, however, has not been shown to improve survival.
Topics: Ascites; Ascitic Fluid; Humans; Peritonitis
PubMed: 2663463
DOI: No ID Found -
Indian Journal of Pediatrics Mar 2024Development of ascites in children with chronic liver disease is the most common form of decompensation. It is associated with a poor prognosis and increased risk of... (Review)
Review
Development of ascites in children with chronic liver disease is the most common form of decompensation. It is associated with a poor prognosis and increased risk of mortality. A diagnostic paracentesis should be performed in liver disease patients with- new-onset ascites, at the beginning of each hospital admission and when ascitic fluid infection (AFI) is suspected. The routine analysis includes cell count with differential, bacterial culture, ascitic fluid total protein and albumin. A serum albumin-ascitic fluid albumin gradient of ≥1.1 g/dL confirms the diagnosis of portal hypertension. Ascites has been reported in children with non-cirrhotic liver disease like acute viral hepatitis, acute liver failure and extrahepatic portal venous obstruction. The main steps in management of cirrhotic ascites include dietary sodium restriction, diuretics and large-volume paracentesis. Sodium should be restricted to maximum of 2 mEq/kg/d (max 90 mEq/d) of sodium/day. Oral diuretic therapy comprises of aldosterone antagonists (e.g., spironolactone) with or without loop-diuretics (e.g., furosemide). Once the ascites is mobilized, the diuretics should be gradually tapered to the minimum effective dosage. Tense ascites should be managed with a large-volume paracentesis (LVP) preferably with albumin infusion. Therapeutic options for refractory ascites include recurrent LVP, transjugular intrahepatic porto-systemic shunt and liver transplantation. AFI (fluid neutrophil count ≥250/mm) is an important complication, and requires prompt antibiotic therapy. Hyponatremia, acute kidney injury, hepatic hydrothorax and hernias are the other complications.
Topics: Child; Humans; Ascites; Peritonitis; Diuretics; Paracentesis; Hypertension, Portal; Serum Albumin; Sodium; Liver Cirrhosis
PubMed: 37310583
DOI: 10.1007/s12098-023-04596-8 -
Clinics in Liver Disease May 2001The evaluation of ascites includes a directed history, focused physical examination, and diagnostic paracentesis with ascitic fluid analysis. Dietary sodium restriction... (Review)
Review
The evaluation of ascites includes a directed history, focused physical examination, and diagnostic paracentesis with ascitic fluid analysis. Dietary sodium restriction and oral diuretics are the mainstay of therapy for the majority of patients with cirrhotic ascites. Transjugular intrahepatic portocaval shunt has emerged as the treatment of choice for selected patients with refractory ascites, although serial large-volume paracenteses should be attempted first. Early diagnosis, broad-spectrum antibiotics, and albumin infusion contribute to the successful management of spontaneous bacterial peritonitis (SBP). Referral for liver transplant evaluation should be considered at the first sign of decompensation and should not be delayed until development of ominous clinical features, such as refractory ascites and SBP.
Topics: Albumins; Anti-Bacterial Agents; Ascites; Ascitic Fluid; Bacterial Infections; Diet, Sodium-Restricted; Diuretics; Humans; Hydrothorax; Liver Cirrhosis; Paracentesis; Peritoneovenous Shunt; Peritonitis; Portasystemic Shunt, Transjugular Intrahepatic
PubMed: 11385975
DOI: 10.1016/s1089-3261(05)70177-x -
Critical Care Nursing Clinics of North... Sep 2010Ascites is the most common complication of cirrhosis, and it often leads to hospitalization. Quality of life and mortality are negatively impacted by ascites. This... (Review)
Review
Ascites is the most common complication of cirrhosis, and it often leads to hospitalization. Quality of life and mortality are negatively impacted by ascites. This article highlights the management of this potentially deadly complication.
Topics: Ascites; Ascitic Fluid; Diuretics; Humans; Liver Cirrhosis; Paracentesis; Physical Examination
PubMed: 20691381
DOI: 10.1016/j.ccell.2010.04.003 -
Medicine Sep 2022Although ascites is a common complication of congestive heart failure, the association between heart failure and hemorrhagic ascites is quite rare. (Review)
Review
INTRODUCTION
Although ascites is a common complication of congestive heart failure, the association between heart failure and hemorrhagic ascites is quite rare.
PATIENT CONCERNS
A 64-year-old woman with recurrent large bloody ascites secondary to heart failure.
DIAGNOSIS
Ascitic fluid assessment revealed red blood cells of 75,125/mm3 and white blood cells of 225/mm3. The total protein in the ascitic fluid was 28.7 g/L, with a high serum ascites albumin gradient. Peritoneal fluid examinations for bacterial culture, acid-fast bacilli (smear and culture), and malignant cell cytology were negative.
INTERVENTIONS
The patient was managed with therapeutic paracentesis, aggressive diuresis, and optimization of her heart failure medications.
OUTCOMES
The patient's symptoms improved dramatically and was discharged in a stable condition.
CONCLUSION
Congestive heart failure should be considered as a potential cause of hemorrhagic ascites after ruling out other serious causes.
Topics: Albumins; Ascites; Ascitic Fluid; Female; Heart Failure; Hemoperitoneum; Humans; Middle Aged; Paracentesis
PubMed: 36197224
DOI: 10.1097/MD.0000000000030708 -
Clinical Chemistry and Laboratory... Jun 2024Ascites is the pathological accumulation of fluid within the peritoneal cavity. It often occurs as results of liver cirrhosis, malignant neoplasia, tuberculous... (Review)
Review
Ascites is the pathological accumulation of fluid within the peritoneal cavity. It often occurs as results of liver cirrhosis, malignant neoplasia, tuberculous infection, cardiac insufficiency, renal diseases, etc. Determining the etiology is an essential step in the management of patients with new-onset ascites. Abdominal paracentesis with appropriate ascitic fluid analysis is probably the most cost-effective method of determining the cause of ascites. We performed a literature search of PubMed and identified articles published in the field of ascites, to evaluate diagnostic values of various parameters in defining the etiologies of ascites and then provides diagnostic algorithm for patients with new-onset ascites. In patients with ascites, the constituent ratio of underlying etiology varies between developed and developing countries. It is a challenge to define the etiologies of ascites in developing countries. Routine ascitic fluid analysis should include the serum ascites albumin gradient (SAAG), total protein concentration, cell count and differential. Optional ascitic fluid analysis includes cholesterol, fluid culture, cytology, tumor markers, lactate dehydrogenase, adenosine deaminase (ADA), triglyceride, amylase, glucose, brain natriuretic peptide (BNP), etc. Our review evaluated diagnostic values of the above parameters in defining the etiologies of ascites. Diagnostic algorithm established in this review would provide a practical and convenient diagnostic strategy for clinicians in diagnosing patients with new-onset ascites.
Topics: Humans; Ascites; Ascitic Fluid; Algorithms; Diagnosis, Differential
PubMed: 38112289
DOI: 10.1515/cclm-2023-1112 -
Indian Journal of Pediatrics Sep 2006Ascites is a common clinical problem in children with liver disease. The peripheral arterial vasodilation hypothesis is mostly accepted as the pathophysiological basis... (Review)
Review
Ascites is a common clinical problem in children with liver disease. The peripheral arterial vasodilation hypothesis is mostly accepted as the pathophysiological basis of ascites. The most important complication is spontaneous ascitic fluid infection in the form of spontaneous bacterial peritonitis (SBP) and its variants. Aerobic gram-negative bacteria, primarily Escherichia coli, are the most common isolates. Diagnostic paracentesis is done in patients with ascites when diagnosed first time and at the beginning of each admission to hospital. Ascitic fluid is evaluated for cell count with differential, albumin level, total protein and culture. Serum-ascites albumin gradient (SAAG) is the best single test for classifying ascites into portal hypertensive (SAAG> 1.1 g/dL) and non-portal hypertensive (SAAG < 1.1 g/dL) causes. In patients with tense ascites LVP should be performed. A neutrophil count of > 250 cells/mm3 is highly suggestive of bacterial peritonitis. Intravenous cefotaxime is the empiric antibiotic of choice. Long-term administration of oral norfloxacin 5-7.5 mg/Kg once a day in cirrhotic patients with ascitic fluid protein content of < 1g/dL or prior episode of SBP is recommended for prevention of SBP. Oral dual diuretic therapy of single morning dose of spironolactone along with furosemide in the ratio of 5:2 is recommended. While obtaining satisfactory diuretic response dual diuretic therapy can be changed over to monotherapy with spironolactone. Patients should be on sodium restricted diet. Management of ascites might ultimately require liver transplantation.
Topics: Ascites; Ascitic Fluid; Bacterial Infections; Child; Humans; Liver Diseases; Peritonitis
PubMed: 17006042
DOI: 10.1007/BF02790393 -
The Western Journal of Medicine May 1981
Topics: Ascites; Ascitic Fluid; Diagnosis, Differential; Female; Humans; Middle Aged; Pericarditis, Constrictive; Proteins
PubMed: 7257349
DOI: No ID Found