Ascites Causes, Management and Treatment, Liver Failure, what causes Ascitis...

2. ASCITES
PREPARED BY
Dr Zain Ul Abidin
Bahawal Victoria Hospital
Bahawalpur
Xe.zain@gmail.com

3. ASCITES
 Derived from the greek word “askos”, meaning bag or sac
 A condition of pathologic fluid accumulation within the
abdominal cavity which is a common complication in liver
cirrhosis.
 Healthy men: have little or no intraperitoneal fluid.
 Healthy women: may have as much as 20ml of
intraperitoneal fluid, depending on phase of menstrual
cycle.

4. Approach to the Patient with Ascites
Peritoneal Causes of Ascites:
1. Malignant ascites
Primary peritoneal mesotheloma
Secondary peritoneal
Carcinomatosis
2. Granulomatous peritonitis
Tuberculous peritonitis
Fungal and parasitic infections
Sarcoidosis
Foreign bodies (cotton, starch, barium)

5. Approach to the Patient with Ascites
3. Vasculitis
Systemic lupus erythematosus
Henoch-schonlein purpura
4. Miscellaneous disorder
Eosinophilic gastroenteritis
Whipple disease
Endometriosis

6. Approach to the Patient with Ascites
Non-Peritoneal Causes of Ascites:
1. Intrahepatic portal hypertension
Cirrhosis
Hepatic failure
Veno-Occlusive disease
2. Extrahepatic portal hypertension
Hepatic vein obstruction
Congestive heart failure

7. Approach to the Patient with Ascites
3. Hypoalbuminemia
Nephrotic syndrome
Malnutrition
4. Miscellaneous disorder
myxedema
Ovarian tumors
Pancreatic & biliary ascites
5. Malignancy, Trauma

8. Pathophysiology
1. Increased hydrostatic pressure
Cirrhosis
Hepatic vein occlusion
IVC obstruction
Cconstrictive pericarditis
Congestive heart failure
2. Decreased colloid osmotic pressure
End stage liver disease
Nephrotic syndrome with protein loss
Malnutrition
Protein-losing enteropathy

9. Pathophysiology
3. Increase permeability of capillaries
Tuberculous peritonitis
Bacterial peritonitis
Malignant disease of the peritoneum
4. Leakage of fluid into the peritoneal cavity
Bile ascites
Pancreatic ascites
Chylous ascites
Urine ascites
5. Miscellaneous causes
Myxedema
Chronic hemodialysis

10. HISTORY OF ASCITES
 Patients should be questioned regarding risk factors
for liver disease since cirrhosis is the most common
cause of ascites.
 Risk factors for hepatitis C should be ruled out.
such as needle sharing, tattoos, cocaine and heroin
use.
 Risk factors for hepatitis B should be rule out.
such as needle sharing, tattoos and acupuncture
 In patients with obesity, diabetes and hyperlipidemia,
NASH should be ruled out.

11. HISTORY OF ASCITES
 Patients with ascites who lack risk factors for cirrhosis
should be questioned about cancer, heart failure, TB,
dialysis and pancreatitis.
 Operative injury to the ureter or bladder can lead to
leakage of urine into peritoneal cavity.
 Patients who are HIV+ may have unusual infections
that lead to ascites formation.