Ascites causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: M.Umer Tariq [2] Carlos A Lopez, M.D. [3]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes of high SAAG ("transudate") are:

• Cirrhosis - 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%)
• Heart failure - 3%
• Budd-Chiari syndrome or veno-occlusive disease
• Constrictive pericarditis

Causes of low SAAG ("exudate") are:

• Cancer (primary peritoneal carcinomatosis and metastasis) - 10%
• Tuberculosis - 2%
• Pancreatitis - 1%
• Serositis
• Nephrotic syndrome

Causes by Organ System

Cardiovascular	Arteriovenous fistula, Budd-Chiari syndrome, cardiac amyloidosiscardiomegaly, cardiomyopathy, cholesterol pericarditis, congestive heart failure, constrictive pericarditis, congestive heart failure, constrictive pericarditis, constrictive tuberculous pericarditis, chylous ascites, cor pulmonale, diffuse neonatal hemangiomatosis, endomyocardial fibrosis, heart failure, inferior vena cava web, lymphedema lymphangiectasia mental retardation, lymphatic obstruction, lymphatic malformation, Kaposiform hemangioendothelioma, obstruction of the inferior vena cava, pericarditis, right heart failure, tricuspid insufficiency, tricuspid regurgitation, tricuspid stenosis, tricuspid valve diseases, veno-occlusive disease, ventriculoperitoneal shunt, Waldmann disease
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acyclovir, mercaptopurine, pramipexole, thalidomide
Ear Nose Throat	No underlying causes
Endocrine	Hypothyroidism, thyroxine deficiency, ovarian hyperstimulation syndrome
Environmental	No underlying causes
Gastroenterologic	Acute liver failure, acute pancreatitis, alcoholic hepatitis, alcoholic liver disease, ascending cholangitis, biliary atresia, biliary fistula, Budd-Chiari syndrome, cholangiocarcinoma, cholecystitis, cholelithiasis, chronic hepatitis,cirrhosis, colorectal cancer, congenital liver fibrosis, end stage liver failure, eosinophilic gastroenteritis, esophageal cancer, Fitz-Hugh-Curtis syndrome, fulminant liver failure, granulomatous peritonitis, hemochromatosis, hepatic failure, hepatic venoocclusive disease with immunodeficiency, hepatitis, hepato-biliary diseases, idiopathic liver cirrhosis, krukenberg tumor, liver cancer, liver damage, Ménétrier's disease, Mosse syndrome, neonatal hepatitis, nodular regenerative hyperplasia of the liver, nutmeg liver, obliterative portal venopathy, obstructive jaundice, pancreatic cancer, pancreatic fistula, peritonitis, portal hypertension, portal vein occlusion, portal vein thrombosis, primary biliary cirrhosis, primary sclerosing cholangitis, pseudomyxoma peritonei, secondary biliary cirrhosis, severe hepatitis, stomach cancer, tuberculous peritonitis, Waldmann disease, Whipple disease
Genetic	No underlying causes
Hematologic	Angioimmunoblastic T-cell lymphoma, Banti syndrome, Bud-chiari syndrome, diffuse neonatal hemangiomatosis, eosinophilic gastroenteritis, erythroblastosis fetalis , extramedullary haemopoiesis, hemolytic disease of the newborn, mastocytosis, Mosse syndrome, Tang Hsi Ryu syndrome
Iatrogenic	No underlying causes
Infectious Disease	Alveolar hydatid disease, amebiasis, bilharzia, chronic hepatitis, chronic viral hepatitis Cytomegalovirus infection, echinococcosis, Epstein-Barr virus infection, filariasis, Fitz-hugh curtis syndrome, acute hepatitis A, acute hepatitis B, acute hepatitis C, acute Hepatitis D, acute hepatitis E, herpes simplex infection, hookworm disease, kaposiform hemangioendothelioma, leptospirosis, malaria, portal hypertension in schistosomiasis, poststreptococcal glomerulonephritis, Rubella virus infection, schistosomiasis, hepatosplenic schistosomiasis, sleeping sickness, strongyloidiasis, stuartbras disease, liver disease in syphilis, toxoplasmosis, tuberculosis, tuberculous peritonitis, tularemia, Whipple disease, yellow fever virus infection
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Crigler-Najjar syndrome, Dubin-Johnson syndrome, Gilbert's syndrome, hemochromatosis, hypoalbuminemia, Kwashiorkor, Rotor's syndrome VLCAD deficiency, Wilson's Disease
Obstetric/Gynecologic	Meigs' syndrome, Mirror syndrome
Oncologic	Anasarca , Angioimmunoblastic T-cell lymphoma, angiosarcoma of the liver, bladder cancer, cholangiocarcinoma, cirrhosis of liver, colorectal cancer, desmoplastic small round cell tumor esophageal cancer, liver cancer, liver cirrhosis, liver metastases, lung cancer, Meig's syndrome, metastatic liver cancer, ovarian cancer, pancreatic cancer, pelvic region cancers, pseudomyxoma peritonei, stomach cancer, WAGR syndrome, Wilms tumor, yolk sac tumor,
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Cor pulmonale, lung cancer, mesothelioma, nephrotic syndrome, pulmonary hypertension
Renal / Electrolyte	Hepatorenal syndrome, Nephrotic syndrome
Rheum / Immune / Allergy	Chronic bacterial infection, erythroblastosis fetalis, eosinophilic gastroenteritis, Eosinophilic peritonitis, hemolytic disease of the newborn, hemolytic anaemia, lethal genital anomalies, hepatic venoocclusive disease with immunodeficiency, hepatoma, immunoproliferative diseases, primary biliary cirrhosis, rectractile mesenteritis, systemic lupus erythematosus,
Sexual	No underlying causes
Trauma	Urinary (due to bladder rupture)
Urologic	No underlying causes
Miscellaneous	Hypervolemia, Idiopathic, Obesity hypoventilation syndrome, POEMS syndrome

Causes in Alphabetical Order

Acute liver failure Acute pancreatitis Alcoholic hepatitis Alcoholic liver disease Alveolar hydatid disease Angioimmunoblastic T-cell lymphoma Bacterial peritonitis Banti's syndrome Biliary fistula Budd-Chiari syndrome Cardiac amyloidosis Cardiac failure, right sided Cholangiocarcinoma Cholesterol pericarditis Chronic hepatitis Chylous ascites Cirrhosis Congestive Heart Failure Constrictive pericarditis Dengue fever Desmoplastic small round cell tumor Eosinophilic gastroenteritis Eosinophilic peritonitis Fasciolopsiasis Fasciolosis Haemochromatosis Hepatic failure Hepatic vein thrombosis Hepatitis C

Hepato-biliary diseases Hepatorenal syndrome Hookworm Hypervolemia Hypoalbuminemia Idiopathic Intestinal lymphatic blockage Kwashiorkor Malignancy Meigs' syndrome Ménétrier's disease Mirror syndrome Nephrotic syndrome Nutmeg liver Obesity hypoventilation syndrome Obstruction of the inferior vena cava Ovarian cancer Ovarian hyperstimulation syndrome Pancreatic fistula Peritonitis POEMS syndrome Portal hypertension Portal vein occlusion Primary biliary cirrhosis Pulmonary hypertension Trauma Tricuspid insufficiency Turner's syndrome Veno-occlusive disease Wilson's Disease

Fetal Ascites

Causes of fetal ascites include:

• Urinary ascites
• Bowel rupture (i.e. meconium peritonitis)
• Ruptured ovarian cyst
• Hydrops
• Pseudoascites
• Infection