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Ascites

Tasaduq Hussain Mir, FAAFP, MD, Afsha Rais Kaisani, FAAFP, MD and Li Wan Reviewed 05/2023
 


BASICS

DESCRIPTION

  • Ascites is the pathologic accumulation of fluid in the peritoneal cavity and the most common complication of cirrhosis (1)

  • It may occur in conditions that cause generalized edema lik...

DIAGNOSIS

History, physical examination and diagnostic abdominal paracentesis are key to diagnosis 

HISTORY

  • Address risk factors (e.g., EtOH use, tuberculosis [TB] exposure, prior malignancies, sexual p...

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 to 1.5 L/day) ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

CMP, CBC, PT/INR should be checked every 6 months to calculate Child-Pugh and Model for End Stage Liver Disease (MELD) 

DIET

Low sodium diet (<...

REFERENCES

1
Chiejina M, Kudaravalli P, Samant H. Ascites. In: StatPearls Treasure Island, FL: StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK470482
2
Gallo A, Dedionigi C, Civitelli ...

ADDITIONAL READING

SEE ALSO

  • Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 ...

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

SNOMED

  • 389026000 Ascites (disorder)

  • 236005001 Malignant ascite...

CLINICAL PEARLS

  • Cirrhosis is the most common cause of ascites.

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

  • First-line treatment: Moderat...

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