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Types of ascites
Causes and symptoms
- Low levels of albumin in the blood that cause a change in the pressure necessary to prevent fluid exchange (osmotic pressure). This change in pressure allows fluid to seep out of the blood vessels.
- An increase in the pressure within the branches of the portal vein that run through liver (portal hypertension). Portal hypertension is caused by the scarring that occurs in cirrhosis. Blood that cannot flow through the liver because of the increased pressure leaks into the abdomen and causes ascites.
- heart or kidney failure
- inflammation and fibrous hardening of the sac that contains the heart (constrictive pericarditis)
- rapid weight gain
- abdominal discomfort and distention
- shortness of breath
- swollen ankles
- hypovolemia (massive loss of blood or fluid)
- azotemia (abnormally high blood levels of nitrogen-bearing materials)
- potassium imbalance
- high sodium concentration. If the patient consumes more salt than the kidneys excrete, increased doses of diuretics should be prescribed
In portal hypertension there is increased pressure within the sinusoids and hepatic veins. As the pressure increases there is movement of protein-rich plasma filtrate into the hepatic lymphatics. Some of the fluid enters the thoracic duct, but if the pressure is high enough, the excess fluid will ooze from the surface of the liver into the peritoneal cavity. Because the fluid has a high colloidal osmotic pressure owing to its high protein content, it is not readily reabsorbed from the peritoneal cavity.
Medical treatment includes restriction of fluid and sodium intake and administration of diuretics. Supplementation of potassium and chloride may be necessary during diuretic therapy to avoid an imbalance of these electrolytes. Careful measurement of intake and output is essential, and laboratory values for the electrolytes must be monitored frequently.
Surgical treatment was at one time almost entirely limited to abdominal paracentesis for removal of large accumulations of ascitic fluid. It is, however, only a temporary measure that poses problems of rapid fluid shift, loss of protein, and the potential for introducing infectious agents into the peritoneum. A more effective procedure is the insertion of a peritoneovenous shunt (LeVeen shunt), which provides a means for continuous reinfusion of ascitic fluid into the venous system.
ascites/as·ci·tes/ (ah-si´tēz) effusion and accumulation of serous fluid in the abdominal cavity.ascit´ic
ascitesThe pathological accumulation of serous fluid in the peritoneal (abdominal) cavity, which common in the decompensated (advanced) liver disease and develops in 50% of those with cirrhosis; patients with cirrhosis who develop ascites have a 50% 2-year survival.
Abdominal distension which, if extreme, causes shortness of breath, portal hypertension and water and Na+ retention.
• Liver—Cirrhosis, alcoholic hepatitis, massive metastases to liver, fulminant hepatic failure, vascular compromise (cardiac failure), Budd-Chiari syndrome, portal vein thrombosis, veno-occlusive disease, fatty liver of pregnancy.
• Extrahepatic—Peritoneal carcinomatosis, peritoneal TB, biliary or pancreatic ascites, nephrotic syndrome, serosal inflammation.
Hypoalbuminaemia, specific gravity < 1.010, protein content of ≤ 3%.
Paracentesis, decreased Na+ in diet, diuretics, liver transplant, peritoneal shunt, transjugular intrahepatic portosystemic shunt (TIPS), extracorporeal ultrafiltration and reinfusion.
Water in the abdomen.
ascitesGI disease A pathologic accumulation of serous fluid in the peritoneal–abdominal cavity, common in decompensated–advanced–liver disease, that develops in 50% of those with cirrhosis; Pts with cirrhosis who develop ascites have a 50% 2-yr survival Etiology-hepatic Cirrhosis, alcoholic hepatitis, massive metastases to liver, fulminant hepatic failure, vascular compromise–cardiac failure, Budd-Chiari syndrome, portal vein thrombosis, veno-occlusive disease, fatty liver of pregnancy extrahepatic origin Peritoneal carcinomatosis, peritoneal TB, biliary or pancreatic ascites, nephrotic syndrome, serosal inflammation Clinical Abdominal distension which, if extreme, causes SOB, portal HTN, water and Na+ retention Lab Hypoalbuminemia, specific gravity < 1.010, protein content of ≤ 3% Treatment Paracentesis, ↓ Na+ in diet, diuretics, liver transplant, peritoneal shunt, transjugular intrahepatic portosystemic shunt–TIPS, extracorporeal ultrafiltration and reinfusion. See Dialysis ascites, Malignant ascites.
Synonym(s): hydroperitoneum, hydroperitonia.
ascites(a-sit'ez) [Gr. askites from askos, a leather bag]
Ascites may be caused by interference in venous return of the heart (as in congestive heart failure), obstruction of flow in the vena cava or portal vein, obstruction in lymphatic drainage, disturbances in electrolyte balance (as in sodium retention), depletion of plasma proteins, cirrhosis, malignancies (such as ovarian cancer), or infections within the peritoneum.
Ventilatory effort, appetite and food intake, fluid intake and output, and weight are assessed. The patient should be advised to limit fluid intake to about 1.5L daily and be educated about a low-sodium diet. Both of these interventions may limit or slow the reaccumulation of fluid in the peritoneum. Abdominal girth is measured at the largest point, and the site marked for future measurements. Paracentesis, if necessary, is explained to the patient. Emotional and physical support are provided to the patient throughout the procedure. Desired outcomes include eased ventilatory effort, improved appetite, improved general comfort, and identification of the cause of the accumulated fluid.
ascitesA collection of fluid in the peritoneal cavity-the space in the ABDOMEN surrounding the internal organs. Ascites occurs in HEART FAILURE, the NEPHROTIC SYNDROME and in CIRRHOSIS of the LIVER.
Patient discussion about ascites
Q. Does ascites mean it's the end? My mother, age 65 was diagnosed with ovarian cancer in a routine US examination. It was also diagnosed she already has mild ascites. Does that mean her cancer is metastatic?