II. Definitions
- Ascites
- Accumulation of peritoneal fluid
III. Symptoms
- Small amount of Ascites
- Asymptomatic
- Large amount of Ascites
- Abdominal Distention and discomfort
- Anorexia
- Nausea
- Early satiety
- Heartburn (Gastroesophageal Reflux)
- Flank Pain
- Respiratory distress
IV. Signs
- Umbilicus may evert
- Bulging flanks with patient lying supine
- Weight of ascitic fluid pushes against side walls
- Tympany at the top of the abdominal curve
- Patient lies supine
- Gas filled bowel floats upward over Ascites
- Fluid Wave Test
- Shifting Dullness Test
- Puddle Sign
V. Causes
- See Ascites Causes
- Most common causes
- Cirrhosis (Cirrhotic Ascites): 85% of cases
- Cancer (Malignant Ascites)
- Congestive Heart Failure
- Tuberculosis
VI. Labs
- Diagnostic abdominal Paracentesis in all cases
- Ascites Fluid: Serum Ascites albumin gradient (SAAG)
- Gradient is the difference between Serum Albumin and Ascites albumin
- Greater difference (SAAG>1.1 g/dl) implies Portal Hypertension
- Exudate or Low Gradient Ascites (Serum to Ascites albumin gradient <1.1 g/dl)
- Peritonitis
- Neoplasm (Malignant Ascites, peritoneal carcinomatosis)
- Pancreatitis
- Vasculitis
- Nephrotic Syndrome
- Biliary or chylous Ascites
- Transudate (Serum to Ascites albumin gradient >1.1 g/dl)
- Gradient is the difference between Serum Albumin and Ascites albumin
- Ascites Fluid: Cell Count with Differential
- Ascites Red Blood Cells (RBC) elevated
- Neoplasm (Malignant Ascites)
- Tuberculous Peritonitis (variably elevated)
- Pancreatitis (variably elevated)
- Ascites White Blood Cells <250 cells/mm3
- Serum to Ascites Albumin Gradient (SAAG) < 1.1 g/dl
- Fluid total Protein >2.5: Cardiac Ascites
- Fluid total Protein <2.5: Cirrhotic Ascites
- Serum to Ascites Albumin Gradient (SAAG) > 1.1 g/dl
- Fluid total Protein <2.5: Nephrotic Ascites
- Serum to Ascites Albumin Gradient (SAAG) < 1.1 g/dl
- Ascites White Blood Cells >500 (or PMNs >250)
- WBC Differential <50% Neutrophils (PMNs)
- Peritoneal carcinomatosis (>50% Lymphocytes)
- Search for primary tumor
- Tuberculous Peritonitis (>70% Lymphocytes)
- Culture fluid for Tuberculosis
- Peritoneal carcinomatosis (>50% Lymphocytes)
- WBC Differential >50% Neutrophils (PMNs)
- Pancreatic Ascites (Fluid amylase >100 U/L)
- Evaluate with Abdominal CT
- Spontaneous Bacterial Peritonitis (single colony)
- Bacterial peritonitis (polymicrobial)
- White Blood Cell Count often > 10,000
- Fluid total Protein >1 g/dl
- Fluid Glucose <50 mg/dl
- Fluid LDH >225 U/L
- Pancreatic Ascites (Fluid amylase >100 U/L)
- WBC Differential <50% Neutrophils (PMNs)
- Ascites Red Blood Cells (RBC) elevated
- Ascites fluid color
- Transparent to cloudy yellow or clear (typical)
- Dark brown: Obtain quantitative fluid Bilirubin
- Milky: Obtain Triglyceride concentration
- Bloody: Adjust Leukocyte count
- Subtract 1 White Blood Cell per 750 Red Blood Cells
- Subtract 1 Neutrophil (PMN) per 250 Red Blood Cells
- Ascites fluid assorted labs
- Lactate Dehydrogenase
- Amylase
- pH
- Lipids
- Culture and cytology
VII. Diagnostics: Diagnostic Paracentesis
- Identify site at linea alba, 2 cm below Umbilicus
- Use 22 gauge needle with catheter
VIII. Imaging
-
Ultrasound
Abdomen or CT Abdomen
- Very sensitive for ascitic fluid
IX. Management
- Treat the underlying condition (e.g. Right Heart Failure)
- Cirrhosis
- Malignant Ascites
- Paracentesis offers symptomatic relief as needed
- Medication Management
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Related Studies
| Definition (CHV) | An abnormal accumulation of serous fluid in the abdominal cavity |
| Definition (CHV) | An abnormal accumulation of serous fluid in the abdominal cavity |
| Definition (NCI_CTCAE) | A disorder characterized by accumulation of serous or hemorrhagic fluid in the peritoneal cavity. |
| Definition (NCI) | Accumulation of fluid in the peritoneal cavity. The fluid may be serous, hemorrhagic, or the result of tumor metastasis to the peritoneum. |
| Definition (NCI_NCI-GLOSS) | Abnormal buildup of fluid in the abdomen that may cause swelling. In late-stage cancer, tumor cells may be found in the fluid in the abdomen. Ascites also occurs in patients with liver disease. |
| Definition (MSH) | Accumulation or retention of free fluid within the peritoneal cavity. |
| Definition (CSP) | effusion and accumulation of serous fluid in the abdominal cavity. |
| Concepts | Finding (T033) |
| MSH | D001201 |
| ICD9 | 789.5 |
| ICD10 | R18 , R18.8 |
| SnomedCT | 207252009, 207254005, 158530005, 13124004, 389026000 |
| HL7 | ASCIT |
| French | ASCITE, Ascite, Ascites, Épanchement péritonéal |
| Portuguese | ASCITE, Ascite |
| Spanish | ASCITIS, [D]ascitis (categoría dependiente del contexto), [D]ascitis, SAI (categoría dependiente del contexto), líquido ascítico, [D]ascitis, SAI (situación), [D]ascitis (situación), [D]ascitis, [D]ascitis, SAI, hidroperitoneo, ascitis (trastorno), ascitis, Ascitis |
| German | ASZITES, Aszites |
| English | [D]Ascites, [D]Ascites NOS, [D]Ascites (context-dependent category), [D]Ascites NOS (context-dependent category), abdominal dropsy, hydrops abdominis, peritoneal dropsy, peritoneal exudate, hydroperitonia, abdominal ascites, ascites (physical finding), ascites (diagnosis), ascites, abdomen ascites, ascites was discovered, Ascites NOS, Ascites [Disease/Finding], [D]Ascites (situation), [D]Ascites NOS (situation), ASCITES, Hydroperitoneum, Hydroperitonia, Abdominal dropsy, Hydrops abdominis, Peritoneal dropsy, Ascites (disorder), abdominis; hydrops, hydroperitoneum, hydrops; abdominis, Ascites, NOS, Ascites |
| Japanese | 腹水, ﾌｸｽｲ |
| Swedish | Vätska i buken |
| Czech | ascites, Ascites |
| Finnish | Askites |
| Russian | ASTSIT, АСЦИТ |
| Korean | 복수 |
| Croatian | ASCITES |
| Polish | Wodobrzusze, Puchlina brzuszna |
| Hungarian | Ascites |
| Norwegian | Ascites, Væske i bukhulen |
| Dutch | abdominis; hydrops, hydrops; abdominis, ascites, Ascites |
| Italian | Ascite |
