Ascites

Ascites is a topic covered in the Pocket ICU Management.

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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

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Last updated: June 15, 2010