Ascites classification

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

Classification

Ascites can be classified based on etiology:

• Portal hypertension
  • Cirrhosis
  • Alcoholic hepatitis
  • Acute liver failure
  • Hepatic veno-occlusive disease
  • Heart failure
  • Constrictive pericarditis
  • Hemodialysis-associated ascites
• Hypoalbuminemia
  • Nephrotic syndrome
  • 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):

• 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).