Ascites

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: 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
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Malik A. (2020) Peritoneum and Retroperitoneum. In: Lee E., Liszewski M., Gee M., Daltro P., Restrepo R. (eds) Pediatric Body MRI. Springer, Cham. doi.org/10.1007/978-3-030-319...
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