Explore 5-Minute Clinical Consult - view these FREE monographs:
-- The first section of this topic is shown below --
Accumulation of fluid in the peritoneal cavity; may occur in conditions that cause generalized edema
- Children: Nephrotic syndrome and malignancy most common
- Adults: Cirrhosis, heart failure, nephrotic syndrome, peritonitis most common
- ~85% of all cases of ascites are caused by liver disease and cirrhosis.
~50–60% of patients with cirrhosis will develop ascites within 10 years.
10% of patients with liver cirrhosis have ascites.
- May develop as a consequence of sustained portal hypertension (portal pressure >12 mm Hg). Interactions of biochemical mediators (e.g., nitric oxide) lead to decreased systemic vascular resistance, splanchnic arterial vasodilation, reduced effective circulating arterial blood volume, and reduced renal perfusion.
- Renal hypoperfusion contributes to activation of systemic vasoconstrictors and antinatriuretic mechanisms, stimulating the sympathetic nervous system and renin-angiotensin-aldosterone system, ultimately culminating in sodium and water retention causing development of ascites and edema.
- Acute liver failure
- Hepatitis (alcoholic, viral, autoimmune, drugs)
- Peritoneal infection and inflammation:
- Bacterial infection (foreign body, fistula), tuberculosis, fungal disease, parasitic infection
- Perforated viscus
- Granulomatous peritonitis (e.g., sarcoidosis)
- Metabolic diseases:
- Cirrhosis or prehepatic and posthepatic portal hypertension
- Nephrotic syndrome
- Protein malnutrition (hypoalbuminemia <2 g/dL)
- Cardiac congestion:
- Congestive heart failure (CHF), constrictive pericarditis
- Pancreatic or biliary fistula
- Lymphatic tear (chylous ascites), hemoperitoneum (trauma, ectopic pregnancy, tumor)
- Peritoneal seeding: Ovarian, colon, pancreas, others
- Primary peritoneal carcinoma, leukemia, or lymphoma
- Mixed (>1 of the above causes, e.g., cirrhosis and cancer)