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{{CMG}} {{AE}} {{MUT}}
{{CMG}}; {{AE}} {{EG}}


==Overview==
==Overview==
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==Classification==
==Classification==
Ascites can be classified based on etiology:
<small>
* Portal hypertension
{{family tree/start}}
** Cirrhosis  
{{family tree| | | | | | | | | | | | | | B01 | | | | | | | | | |B01='''Ascites classification'''}}
** Alcoholic hepatitis  
{{family tree| | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | }}
** Acute liver failure  
{{family tree| | | | | | | C01 | | | | | | | | | | | C02 | | | |C01=Based on [[Etiology]]|C02=Based on [[SAAG]]}}
** Hepatic veno-occlusive disease
{{family tree| |,|-|-|-|v|-|^|-|v|-|-|-|.| | | | |,|-|^|-|.| | }}
** Heart failure  
{{family tree| D01 | | D02 | | D03 | | D04 | | | D05 | | D06 |D01=[[Portal hypertension]]|D02=[[Hypoalbuminemia]]|D03=[[Peritoneal]] disease|D04=Other etiologies|D05=High ([[SAAG]] > 1.1 g/dL)|D06=Low ([[SAAG]] < 1.1 g/dL)}}
** Constrictive pericarditis  
{{family tree| |!| | | |!| | | |!| | | |!| | | | |!| | | |!| | }}
** Hemodialysis-associated ascites
{{family tree| boxstyle=text-align: left; | E01 | | E02 | | E03 | | E04 | | | E05 | | E06 |E01=• [[Cirrhosis]]<br>• [[Alcoholic hepatitis]]<br>• [[Acute liver failure]]<br>• [[Hepatic]] veno-occlusive disease<br>• [[Heart failure]]<br>• [[Constrictive pericarditis]]<br>• [[Hemodialysis]]-associated|E02=• [[Nephrotic syndrome]]<br>• [[Protein]]-losing [[enteropathy]]<br>• Severe [[malnutrition]]|E03=• [[Malignant]] ascites<br>• Infectious [[peritonitis]]<br>• [[Eosinophilic]] [[gastroenteritis]]<br>• Starch [[granulomatous peritonitis]]<br>• [[Peritoneal dialysis]]<br>• Multicystic [[mesothelioma]] ([[peritoneal inclusion cyst]])|E04=• [[Chylous ascites]]<br>• [[Pancreatic]] ascites<br>• [[Myxedema]]<br>• [[Hemoperitoneum]]<br>• [[Urologic]] injury|E05=• [[Cirrhosis]]<br>• [[Fulminant hepatic failure]]<br>• Veno-occlusive disease<br>• [[Hepatic vein obstruction]] (ie, [[Budd-Chiari syndrome]])<br>• [[Congestive heart failure]]<br>• [[Nephrotic syndrome]]<br>• [[Protein]]-losing [[enteropathy]]<br>• [[Malnutrition]]<br>• [[Myxedema]]<br>• [[Ovarian]] [[tumors]]<br>• [[Pancreatic]] ascites<br>• [[Biliary]] ascites<br>• [[Malignancy]]<br>• [[Trauma]]<br>• [[Portal hypertension]]|E06=• Primary [[peritoneal]] [[mesothelioma]]<br>• Secondary [[peritoneal]] [[carcinomatosis]]<br>• [[Tuberculous]] [[peritonitis]]<br>• [[Fungal]] and [[parasitic]] infections (eg, [[Candida]], [[Histoplasma capsulatum|Histoplasma]], [[Cryptococcus]], [[Schistosoma mansoni]], [[Strongyloides]], [[Entamoeba histolytica]])<br>• [[Sarcoidosis]]<br>• [[Foreign bodies]] (i.e., talc, cotton and wood fibers, [[starch]], [[barium]])<br>• [[Systemic lupus erythematosus]]<br>• [[Henoch-Schönlein purpura]]<br>• [[Eosinophilic]] [[gastroenteritis]]<br>• [[Whipple disease]]<br>• [[Endometriosis]]}}
* Hypoalbuminemia
{{family tree/end}}
** Nephrotic syndrome
</small>
** Protein-losing enteropathy
 
** Severe malnutrition
 
* Peritoneal disease
** Malignant ascites  
** Infectious peritonitis
** Eosinophilic gastroenteritis
** Starch granulomatous peritonitis
** Peritoneal dialysis  
** Multicystic mesothelioma (peritoneal inclusion cysts)  
* Other etiologies
** Chylous ascites  
** Pancreatic ascites  
** Myxedema  
** Hemoperitoneum  
** Urologic injury
Ascites is broadly classified as two types based on the [[Serum-ascites albumin gradient]] (SAAG):
Ascites is broadly classified as two types based on the [[Serum-ascites albumin gradient]] (SAAG):
* Transudate - SAAG > 1.1 g/dL (indicates the ascites is due to [[portal hypertension]]).
* Transudate - SAAG > 1.1 g/dL (indicates the ascites is due to [[portal hypertension]]).

Revision as of 16:40, 8 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Classification

 
 
 
 
 
 
 
 
 
 
 
 
 
Ascites classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on Etiology
 
 
 
 
 
 
 
 
 
 
Based on SAAG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Portal hypertension
 
Hypoalbuminemia
 
Peritoneal disease
 
Other etiologies
 
 
High (SAAG > 1.1 g/dL)
 
Low (SAAG < 1.1 g/dL)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Cirrhosis
• Alcoholic hepatitis
• Acute liver failure
• Hepatic veno-occlusive disease
• Heart failure
• Constrictive pericarditis
• Hemodialysis-associated
 
• Nephrotic syndrome
• Protein-losing enteropathy
• Severe malnutrition
 
• Malignant ascites
• Infectious peritonitis
• Eosinophilic gastroenteritis
• Starch granulomatous peritonitis
• Peritoneal dialysis
• Multicystic mesothelioma (peritoneal inclusion cyst)
 
• Chylous ascites
• Pancreatic ascites
• Myxedema
• Hemoperitoneum
• Urologic injury
 
 
• Cirrhosis
• Fulminant hepatic failure
• Veno-occlusive disease
• Hepatic vein obstruction (ie, Budd-Chiari syndrome)
• Congestive heart failure
• Nephrotic syndrome
• Protein-losing enteropathy
• Malnutrition
• Myxedema
• Ovarian tumors
• Pancreatic ascites
• Biliary ascites
• Malignancy
• Trauma
• Portal hypertension
 
• Primary peritoneal mesothelioma
• Secondary peritoneal carcinomatosis
• Tuberculous peritonitis
• Fungal and parasitic infections (eg, Candida, Histoplasma, Cryptococcus, Schistosoma mansoni, Strongyloides, Entamoeba histolytica)
• Sarcoidosis
• Foreign bodies (i.e., talc, cotton and wood fibers, starch, barium)
• Systemic lupus erythematosus
• Henoch-Schönlein purpura
• Eosinophilic gastroenteritis
• Whipple disease
• Endometriosis


Ascites is broadly classified as two types based on the Serum-ascites albumin gradient (SAAG):

  • Transudate - SAAG > 1.1 g/dL (indicates the ascites is due to portal hypertension).
  • Exudate - SAAG < 1.1 g/dL (indicates the ascites is due to non-portal hypertension etiology).

References

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