Ascites – Causes and Treatment

Ascites

Collection of the flid in peritoneal cavity is called ascites.

At least 1500 mL of flid must collect in peritoneal cavity before physical examination.

Pathogenesis of ascites

Causes of ascites

1. Disease of peritoneum

1. Infections Ascites

• Tuberculous peritonitis.
• Spontaneous bacterial peritonitis.
• Fungal­Candida, histoplasma.
• Parasitic — Schistosoma, enterobius.
• Viral — Acute severe hepatitis.

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2. Neoplasms Ascites

• Primary mesothelioma.
• Secondary carcinomatosis, e.g. adenocarcinoma,sarcoma, teratoma, leukemia, Hodgkin’s disease,lymphocytic lymphoma, myeloid metaplasia.
• Pseudomyxoma peritonei

3. Familial paroxysmal peritonitis

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4. Miscellaneous Ascites

• Vasculitis — SLE and other collagen vascular diseases, allergic vasculitis (Henoch­Schonlein purpura).
• Eosinophilic gastroenteritis.
• Whipple’s disease.
• Granulomatous peritonitis — Sarcoidosis,
• Crohn’s disease, starch peritonitis.
• Peritoneal loose bodies.
• Peritoneal encapsulation.

2. Portal hypertension Ascites

3. Congestive heart failure Ascites

4. Hypoalbuminemia Ascites

• Nephrosis
• Malnutrition
• Protein­losing enteropathy

5. Beri­beri Ascites

6. Myxedema Ascites

7. Ovarian disease:

• Meigs syndrorne
• Struma ovari
• Ovarian overstimulation syndrome
• Pancreatic ascites due to retroperitoneal leakage of pancreatic enzymes from a ruptured cyst or pancreatic duct.
• Bile ascites
• Chylous ascites
• Epidemic dropsy

Investigations Ascites or Ascites Treatment

• Ultrasonography: USG of abdomen shows presence of minimum amount of fluid and is very needful when clinical signs are absent. This used for guiding paracentesis.
• Paracentesis: Abdominal paracentesis is done which helps in determination of etiology.
• In cirrhosis, ascitic flid is clear and straw coloured. The flid is milky white in chyle ascites while it is cloudy in infections. Hemorrhagic flid is seen due to trauma, tumor or tuberculosis.
• Presence of more than 500 leucocytes/µL is suggestive of inflmmatory conditions.
• Basedonthespecifigravityandtotalproteinconcentration,ascitic flid has traditionally been classifid as transudative and exudative.

Management of Ascites or Ascites Treatment

• In every case of ascites oral diuretics, i.e. furosemide 40 to 80 mg + spironolactone 25 to 100 mg is administered.
• Sodium intake is restricted and diet which is low in sodium is given.
• In case of massive ascites which produce cardiorespiratory enlargement, abdominal paracentesis is done and flid is drained slowly. Fluid should not be drained quickly because it causes vasovagal attck.
• Portac aval shunt surgery or implantation of peritoneovenous shunt can be done in refractory ascites.