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Ascites

Daniel J. Stein, MD, MPH and Stephen K. Lane, MD, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Accumulation of fluid in the peritoneal cavity; may occur in conditions that cause generalized edema

  • Men generally have no fluid in peritoneal cavity; women may have up to 20 mL depen...

DIAGNOSIS

HISTORY

  • Address risk factors (e.g., EtOH use, TB exposure, prior malignancies, sexual partners, transfusion history, metabolic syndrome, increased risk of nonalcoholic steatohepatitis progres...

TREATMENT

For all patients: 
  • Daily weight

  • Restrict dietary sodium to ≤2 g/day if the cause is due to portal hypertension (high SAAG) (1)[A].

  • Water restriction (1 to 1.5 L/day) only necessary if serum sod...

ONGOING CARE

PROGNOSIS

  • Prognosis varies depending on underlying cause.

  • Ascites in itself is rarely life-threatening but can signify life-threatening underlying disease (e.g., cancer, end-stage liver dis...

REFERENCES

1 Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. http://www.aasld.org/sites/default/files/guideline_documents/adultascitesenhanced.pdf. Accessed July 3...

ADDITIONAL READING

Perumalswami PV, Schiano TD. The management of hospitalized patients with cirrhosis: the Mount Sinai experience and a guide for hospitalists. Dig Dis Sci.  2011;56(5):1266–1281...

SEE ALSO

  • Cirrhosis of the Liver; Hepatorenal Syndrome

  • Algorithms: Congestive Heart Failure: Differential Diagnosis; Nephrotic Syndrome

CODES

ICD10

  • R18.8 Other ascites

  • R18.0 Malignant ascites

  • K70.31 Alcoholic cirrhosis of liver with ascites

  • K70.11 Alcoholic hepatitis with ascites

ICD9

  • 789.59 Other ascites

  • 789.51 Malignant ascites

SNOMED

  • 389026...

CLINICAL PEARLS

  • Cirrhosis is the most common cause of ascites.

  • Patients with new-onset ascites or hospitalized patients with ascites should undergo diagnostic paracentesis.

  • Avoid ACE inhibitors, ARBs, a...

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