Ascites

Pathophysiology

  • In portal hypertension → systemic vasodilatation (? due to release of NO) → ↓ effective arterial volume → renal Na retention → volume overload and ascites
  • In malignant or inflammatory ascites, leaking of proteinaceous material occurs from tumor or from inflamed/infected/ruptured intraabdominal structures

Symptoms

  • ↑ abd girth, wt gain, new abd hernia, abd pain, dyspnea, nausea, early satiety

Evaluation (World J Hepatol 2013;5:251; JAMA 2016;316:340)

  • Physical exam: flank dullness (>1500 mL needed), shifting dullness (Se ~83%)
  • Radiologic: U/S detects >100 mL; MRI/CT (also help with Ddx)
  • Paracentesis (Hep