Ascites resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]

Ascites resident survival guide Microchapters
Overview
Classification/Causes
FIRE
Diagnosis
Treatment
Do's
Dont's

Overview

Accumulation of fluid within the peritoneal cavity results in ascites. Most important for a successful treatment of ascites is an accurate diagnosis of its cause. Most common causes are portal hypertension, malignancy and heart failure. The diagnosis is made with a combination of physical examination and abdominal imaging. The next step is typically a paracentesis to evaluate the ascitic fluid for causes.

Classification/Causes

Ascites can be classified based on the underlying causes. Common causes are:

Causes

Portal hypertension: ❑  Cirrhosis ❑  Alcoholic hepatitis ❑  Acute liver failure ❑  Hepatic veno-occlusive disease (eg, Budd-Chiari syndrome) ❑  Heart failure ❑  Constrictive pericarditis ❑  Hemodialysis-associated ascites (nephrogenic ascites)

Hypoalbuminemia: ❑  Nephrotic syndrome ❑  Protein-losing enteropathy ❑  Severe malnutrition

Peritoneal disease: ❑  Malignant ascites ❑  Infectious peritonitis ❑  Eosinophilic gastroenteritis ❑  Starch granulomatous peritonitis ❑  Peritoneal dialysis

Hypoalbuminemia: ❑  Nephrotic syndrome ❑  Protein-losing enteropathy ❑  Severe malnutrition

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

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Complete Diagnostic Approach

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Treatment

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References