Ascites

First Things First (assess for & treat the following)

Clinical manifestations occur in 2 basic situations:

• Normal peritoneum
  
  • Portal hypertension (SAAG >1.1 g/dL)
    • Hepatic congestion
      • Congestive heart failure
      • Constrictive pericarditis
      • Tricuspid insufficiency
      • Budd-Chiari syndrome
      • Veno-occlusive disease
    • Liver disease
      • Cirrhosis
      • Alcoholic hepatitis
      • Fulminant hepatic failure
      • Massive hepatic metastases
      • Hepatic fibrosis
      • Acute fatty liver of pregnancy
      • Nonalcoholic steatohepatitis (NASH)
    • Portal vein occlusion
  • Hypoalbuminemia (SAAG < 1.1 g/dL)
    • Nephrotic syndrome
    • Protein-losing enteropathy
    • Severe malnutrition with anasarca
  • Miscellaneous conditions (SAAG < 1.1 g/dL)
    • Chylous ascites
    • Pancreatic ascites
    • Bile ascites
    • Pancreatic ascites

• Diseased peritoneum (SAAG < 1.1 g/dL)
  • Infectious
    • Bacterial peritonitis
      • Spontaneous bacterial peritonitis
        • Usually single organism
      • Secondary bacterial peritonitis
        • Usually multiple organisms
    • Tuberculous peritonitis
    • Fungal peritonitis
    • HIV-associated peritonitis
    • Amebiasis peritonitis
  • Malignant
    • Peritoneal carcinomatosis
    • Primary mesothelioma
    • Pseudomyxoma peritonei
    • Massive hepatic metastases
    • Hepatocellular carcinoma