Ascites differential diagnosis

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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

Diseases that cause ascites should differentiate from each others, such as cirrhosis, Alcoholic hepatitis, Budd-Chiari syndrome, Constrictive pericarditis, Heart failure, Myxedema, Cancer, Nephrotic syndrome, Pancreatitis, Serositis, and Tuberculosis. The ascites may be transudate (serum-ascites albumin gradient [SAAG] ≥ 1.1 g/dL) or exudate (serum-ascites albumin gradient [SAAG] < 1.1 g/dL).

Differentiating Other Diseases Caused Ascites

• Diseases that cause ascites should differentiate from each others, such as cirrhosis, Alcoholic hepatitis, Budd-Chiari syndrome, Constrictive pericarditis, Heart failure, Myxedema, Cancer, Nephrotic syndrome, Pancreatitis, Serositis, and Tuberculosis.
• The ascites may be transudate (serum-ascites albumin gradient [SAAG] ≥ 1.1 g/dL) or exudate (serum-ascites albumin gradient [SAAG] < 1.1 g/dL).

Type	Diseases	History and Symptoms								Physical Examination						Laboratory Findings							Other Findings
		GI symptoms				Extra-GI symptoms										Liver function test				Biochemical test
		Jaundice	Abdominal pain	Hematemesis	Nausea	Weight loss	Dyspnea	Cough	Chest pain	Fever	Spider angioma	Abdominal tenderness	Jugular venous distention	Pitting edema	Muffled heart sounds	ALT	AST	Bili	Amylase /Lipase	Cr	ESR	Na-K
Transudate (SAAG≥ 1.1g/dL)	Cirrhosis	++	+	+	+	+	-	-	-	-	+	+	-	-	-	↑↑	↑↑	↑↑	Normal	Normal	Normal	Normal	Esophageal varices Gynecomastia Testicular atrophy
	Alcoholic hepatitis	-	-	-	+	+	-	-	-	+	-	-	-	-	-	↑	↑↑↑	Normal	Normal	Normal	Normal	Normal	Fatty liver disease Loss of appetite
	Budd-Chiari syndrome	-	+	-	+	+	-	-	-	+	-	-	-	-	-	↑	↑	Normal	Normal	Normal	↑	Normal	Hepatosplenomegaly Hypercoagulopathy
	Constrictive pericarditis	-	-	-	-	-	+	-	+	+	-	-	++	-	+	Normal	Normal	Normal	Normal	Normal	↑	Normal	Pulsus paradoxus Fatigue
	Heart failure	-	-	-	-	+	+	+	+	-	-	-	+	+	-	Normal	Normal	Normal	Normal	Normal	Normal	↑	Declined functional class Fatigue
	Myxedema	-	-	-	-	-	+	-	-	-	-	-	-	++	-	Normal	Normal	Normal	Normal	Normal	Normal	↓	Generalized edema Low body temperature
	Portal hypertension	+/-	+	+	+	+	-	-	-	-	+	-	-	-	-	↑	↑	↑	Normal	↑	Normal	Normal	Esophageal varices Hepatosplenomegaly
Exudate (SAAG< 1.1g/dL)	Cancer	+	+	-	+	++	-	-	-	-	-	-	-	-	-	Normal	Normal	Normal	Normal	Normal	↑↑	Normal	-
	Nephrotic syndrome	-	-	-	+	-	-	-	-	-	-	-	-	++	-	Normal	Normal	Normal	Normal	↑↑	↑	↑↑	Proteinuria Hypoalbuminemia
	Pancreatitis	+/-	+++	-	++	-	-	-	+	+	-	++	-	-	-	Normal	Normal	Normal	↑↑	Normal	↑	Normal	Radiating pain to back Gallstone
	Serositis	-	+	-	+	+	-	-	+/-	+	-	+	-	-	-	Normal	Normal	Normal	Normal	Normal	↑	Normal	-
	Tuberculosis	-	+	-	+	+	++	++	++	+/-	-	+	-	-	-	Normal	Normal	Normal	Normal	Normal	↑↑	Normal	Chronic cough Night sweat