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Ascites (Pathophysiology, Symptoms, Examination)

In most healthy individuals, there is very little free intraperitoneal fluid; some women may have about 20 ml during the menstrual cycle. Ascites is the pathologic accumulation of fluid within the peritoneal cavity. It is the most common complication of cirrhosis and occurs in about 50% of patient with decompensated cirrhosis in 10 years. The development of ascites denotes the transition from compensated to decompensated cirrhosis. Under normal circumstances, the amount of peritoneal fluid depends on a balance between plasma flowing into and out of the blood and lymphatic vessels. It is only when this balance has been disrupted does ascites form. This imbalance may be due to increased capillary permeability, increased venous pressure, decreased protein (oncotic pressure), or increased lymphatic obstruction. Ascites is one of the most frequent complications of cirrhosis and portal hypertension. Up to 50% of cirrhotic patients will develop ascites within a 10 year follow-up period. Hepatic cirrhosis accounts for up to 85% of cases of ascites, and malignancies account for approximately 10%. Other than cirrhosis, hepatic causes of ascites include: Hepatic venous outflow obstruction (Hepatic vein obstruction, Budd-Chiari syndrome, Veno-occlusive disease) Portal vein occlusion Inferior vena cava obstruction Hepatic cancer The other types of ascites are categorized as cardiogenic, nephrogenic, infectious, and miscellaneous. Cardiogenic causes include congestive cardiac failure and constrictive pericarditis. Nephrogenic ascites is due to nephrotic syndrome. Infectious ascites may be caused by: Tuberculous peritonitis Spontaneous bacterial peritonitis Fungal infection Parasite infection Chlamydia infection Malignant ascites may be due to: Ovarian cancer Cervix cancer Endometrial cancer Breast cancer Esophageal cancer Gastric cancer Colorectal cancer Lung cancer Pancreatic cancer Hepatobiliary cancer Primary peritoneal cancer Miscellaneous causes include: Chylous ascites Pancreatic ascites Bile ascites Ovarian disease (Meig’s syndrome, Struma ovarii, Ovarian hyperstimulation) Systemic lupus erythematosis Whipple’s disease Sarcoidosis Reference: Chiejina M, Kudaravalli P, Samant H. Ascites. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NB... Huang LL, Xia HH, Zhu SL. Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites. J Clin Transl Hepatol. 2014;2(1):58-64. doi:10.14218/JCTH.2013.00010 Image credit: Kjpargeter, pch-vector / Freepik @ http://www.freepik.com https://pngtree.com/so/vector https://pngtree.com/so/direction https://en.wikipedia.org/wiki/File:He... https://commons.wikimedia.org/wiki/Fi... https://commons.wikimedia.org/wiki/Fi... Malik A. (2020) Peritoneum and Retroperitoneum. In: Lee E., Liszewski M., Gee M., Daltro P., Restrepo R. (eds) Pediatric Body MRI. Springer, Cham. https://doi.org/10.1007/978-3-030-319... Featured videos: Top 10 Best Medical Universities In The World :    • Top 10 Best Medical Universities In T...   Personal Loan for Medical Procedures :    • Personal Loan for Medical Procedures:...   How Do Insurance Companies Make Money and How Do They Work :    • Insurance Explained - How Do Insuranc...   How Medical Collections affect Mortgage Applications :    • How Medical Collections affect Mortga...   Medical Credit Cards :    • Medical Credit Cards   What is it like to be a Medical Malpractice Attorney :    • What is it like to be a Medical Malpr...   3 Ways How Blockchain Will Change Healthcare :    • 3 Ways How Blockchain Will Change Hea...   How to Start a Medical Supply Business Online :    • How to Start a Medical Supply Busines...   The HIGHEST Paying MEDICAL Degrees :    • The HIGHEST Paying MEDICAL Degrees!   Doctor and Lawyer React To Grey’s Anatomy Malpractice Episode :    • Doctor and Lawyer React To Grey’s Ana...   How to Start a Medical Supply Business Online :    • How to Start a Medical Supply Busines...   Medical Coding Services :    • Introduction to Medical Coding   A spotlight on Rehab & Rehabilitation Medicine :    • A spotlight on Rehabilitation Medicine   Advanced Hair Transplant surgery :    • Advanced Hair Transplant surgery 2020...   Mesothelioma and Malignant Pleural Issues :    • Mesothelioma and Malignant Pleural Is...