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Ascites

Sara Elsayed, MD and Ahmed Aldabdob, MD Reviewed 06/2020
 


BASICS

DESCRIPTION

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

  • Refractory ascites; ascitic fluid that recurs after paracentesis or cannot be prev...

DIAGNOSIS

HISTORY

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

TREATMENT

For all patients, first-line treatment consists of: 
  • Daily weight

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

  • Water restriction (1.0 to 1.5 L/day...

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. https://www.aasld.org/sites/default/files/guideline_documents/141020_Guideline_Ascites_4UFb_2015.pdf. Ac...

ADDITIONAL READING

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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