Abstract
Ascites, the accumulation of fluid in the peritoneal cavity, is the most common complication of cirrhosis and portal hypertension (1). In a prospective study of patients with compensated cirrhosis of all etiologies, the cumulative probability of developing ascites ranges from 35% to 50% in 5 yr (1,2). Although cirrhosis is the cause of ascites in more than 75% of patients, other less common causes of ascites are peritoneal malignancy (12%), cardiac failure (5%), and peritoneal tuberculosis (2%) (3), and these should be considered in the differential diagnosis of ascites. With the increasing use of in vitro fertilization, ascites secondary to severe ovarian hyperstimulation syndrome is being increasingly recognized (4).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
D’Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci 1986;31(5):468–475.
Gines P, Quintero E, Arroyo V. Compensated cirrhosis: natural history and prognosis. Hepatology 1987;7:122–128.
Runyon BA. Ascites. In: Schiff L, Schiff ER, eds. Diseases of the Liver. Lippincott, Philadelphia, PA, 1993, pp. 990–1015.
Fabregues F, Balasch J, Gines P, et al. Ascites and liver test abnormalities during severe ovarian hyperstimulation syndrome. Am J Gastroenterol 1999;94(4):994–999.
Simel DL, Halvorsen RA Jr, Feussner JR. Quantitating bedside diagnosis: clinical evaluation of ascites. J Gen Intern Med 1988;3(5):423–428.
Belghiti J, Durand F. Abdominal wall hernias in the setting of cirrhosis. Sernin Liver Dis 1997;17(3):219–226.
Kirkpatrick S, Schubert T. Umbilical hernia rupture in cirrhotics with ascites. Dig Dis Sci 1988;33(6):762–765.
Lemmer JH, Strodel WE, Eckhauser FE. Umbilical hernia incarceration: a complication of medical therapy of ascites. Am J Gastroenterol 1983;78(5):295–296.
Trotter JF, Suhocki PV. Incarceration of umbilical hernia following transjugular inlrahepatic portosystemic shunt for the treatment of ascites. Liver Transpl Surg 1999;5(3):209–210.
Liebennan FL, Hideniura R, Peters RL, Reynolds TB. Pathogenesis and treatment of hydrothorax complicating cirrhosis with ascites. Ann Intern Med 1966;64(2):341–351.
Rubinstein D, Mclnnes IE, Dudley FJ. Hepatic hydrothorax in the absence of clinical ascites: diagnosis and management. Gastroenterology 1985;88(1 Pt 1):188–191.
Strauss RM, Boyer TD. Hepatic hydrothorax. Sem Liv Dis 1997;17:227–232.
Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-lransudate concept in the differential diagnosis of ascites. Ann Intern Med 1992;117:215–220.
Cattau EL Jr, Benjamin SB, Knuff TE, Castell DO. The accuracy of the physical examination in the diagnosis of suspected ascites. JAMA 1982;247(8):1164–1166.
Cummings S, Papadakis M, Melnick J, Gooding GA, Tierney LM, Jr. The predictive value of physical examinations for ascites. West J Med 1985;142(5):633–636.
Williams JW Jr, Simel DL. The rational clinical examination. Does this patient have ascites? How to divine fluid in the abdomen. JAMA 1992;267(19):2645–2648.
Liatsos C, Hadjileontiadis LJ, Mavrogiannis C, Patch D, Panas SM, Burroughs AK. Bowel sounds analysis: a novel noninvasive method for diagnosis of small-volume ascites. Dig Dis Sci 2003;48(8):1630–1636.
Goldberg BB, Goodman GA, Clearfield HR. Evaluation of ascites by ultrasound. Radiology 1970;96(1):15–22.
Black M, Friedman AC. Ultrasound examination in the patient with ascites. Ann Intern Med 1989;110(4):253–255.
Schuster DM, Mukundan S Jr, Small W, Fajman WA. The use of the diagnostic radionuclide ascites scan to facilitate treatment decisions for hepatic hydrothorax. Clin Nucl Med 1998;23(1):16–18.
Bhattacharya A, Mittal BR, Biswas T, et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax. J Gastroenterol Hepatol 2001;16(3):317–321.
Rimola A, Garcia-Tsao G, Navasa M, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. J Ilepatol 2000;32:142–153.
Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology 1998;27(1):264–272.
McVay PA, Toy PT. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion 1991;31(2):164–171.
Oelsner DH, Caldwell SH, Coles M, Driscoll CJ. Subumbilical midline vascularity of the abdominal wall in portal hypertension observed at laparoscopy. Gastrointest Endosc 1998;47(5):388–390.
Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990;98(1):127–133.
Dwivedi M, Misra SP, Misra V, Kumar R. Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Am J Gastroenterol 1990;85(9):1123–1125.
Garcia-Tsao G. Spontaneous bacterial peritonitis. Gastro Clin North Am 1992;21(1):257–275.
Runyon BA, Akriviadis EA, Keyser AJ. The opacity of portal hypertension-related ascites correlates with the fluid’s triglyceride concentration. Am J Clin Pathol 1991;96(1):142–143.
Rector WG Jr. Spontaneous chylous ascites of cirrhosis. J Clin Gastroenterol 1984;6(4):369–372.
Rovelstad RA, Bartholomew LG, Cain JC, McKenzie BF, Soule EII. Ascites. I. The value of examination of ascitic fluid and blood for lipids and for proteins by electrophoresis. Gastroenterology 1958;34(3):436–451.
Hirabayashi K, Graham J. Genesis of ascites in ovarian cancer. Am J Obstet Gynecol 1970;106(4):492–497.
Witte CL, Witte MH, Dumont AE, Frist J, Cole WR. Lymph protein in hepatic cirrhosis and experimental hepatic and portal venous hypertension. Ann Surg 1968;168(4):567–577.
Witte CL, Witte MH. The congested liver. In: Lautt WW, ed. Hepatic Circulation in Health and Disease. Raven, New York, 1981, pp. 307–323.
Dumont AE, Witte CL, Witte MH. Protein content of liver lymph in patients with portal hypertension secondary to hepatic cirrhosis. Lymphology 1975;8(4):111–113.
Henriksen JH, Horn T, Christoffersen P. The blood-lymph barrier in the liver. A review based on morphological and functional concepts of normal and cirrhotic liver. Liver 1984;4(4):221–232.
Witte CL, Witte MH, Cole WR, Chung YC, Bleisch VR, Dumont AE. Dual origin of ascites in hepatic cirrhosis. Surg Gynccol Obstct 1969;129(5):1027–1033.
Hoefs JC. Increase in ascites white blood cell and protein concentrations during diuresis in patients with chronic liver disease. Hepatology 1981;1(3):249–254.
Hoefs JC. Serum protein concentration and portal pressure determine the ascitic fluid protein concentration in patients with chronic liver disease. J Lab din Med 1983;102:260–273.
Henriksen JH. Colloid osmotic pressure in decompensated cirrhosis. A ‘mirror image’ of portal venous hypertension. Scand J Gastroenterol 1985;20(2):170–174.
Pare P, Talbot J, Hoefs JC. Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites. Gastroenterology 1983;85:240–244.
Rector WG Jr, Reynolds TB. Superiority of the serum-ascites albumin difference over the ascites total protein concentration in separation of “iransudative” and “exudative” ascites. Am J Med 1984;77(1):83–85.
Albillos A, Cuervas-Mons V, Millan I, et al. Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis. Gastroenterology 1990;98(1):134–140.
Hoefs JC. Globulin correction of the albumin gradient: correlation with measured serum to ascites colloid osmotic pressure gradients. Hepatology 1992;16(2):396–403.
Castellote J, Lopez C, Gomals J, et al. Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips. Hepatology 2003;37(4):893–896.
Runyon BA. Strips and tubes: improving the diagnosis of spontaneous bacterial peritonitis. Hepatology 2003;37:745–747.
Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology 1988;95(5):1351–1355.
Bobadilla M, Sifuentes J, Garcia-Tsao G. Improved method for bacteriological diagnosis of spontaneous bacterial peritonitis. J Clin Microbiol 1989;27:2145–2147.
Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 1985;5(3):419–424.
Morali GA, Sniderman KW, Deitel KM, et al. Is sinusoidal portal hypertension a necessary factor for the development of hepatic ascites? J Hepatol 1992;16:249–250.
Casado M, Bosch J, Garcia-Pagan JC, et al. Clinical events after transj ugular intrahepatic portosy stemic shunt: correlation with hemodynamic findings. Gastroenterology 1998;114:1296–1303.
Villanueva C, Minana J, Ortiz J, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med 2001;345:647–655.
Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology 2003;37(4):902–908.
Myers RP, Cerini R, Sayegh R, et al. Cardiac hepatopathy: clinical, hemodynamic, and histologic characteristics and correlations. Hepatology 2003;37(2):393–400.
Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: any thing worth doing should be done right. Hepatology 2004;39(2):280–283.
Colapinto RF. Transjugular biopsy of the liver. Clin Gastroenterol 1985;14:451–467.
Trcjo R, Alvarez W, Garcia-Pagan JC, et al. The applicability and diagnostic effectiveness of trans-jugular liver biopsy. Medicina Clinica 1996;107:521–523.
Moore KP, Wong F, Gines P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003;38(1):258–266.
Arroyo V, Gines P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepato-renal syndrome in cirrhosis. Hepatology 1996;23:164–176.
Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodes J. Peripheral arterial vasodilation hypothesis—A proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988;8:1151–1157.
Fernandez-Esparrach G, Sanchez-Fueyo A, Gines P, et al. A prognostic model for predicting survival in cirrhosis with ascites. J Hepatol 2001;34(1):46–52.
Arroyo V, Rodes J, Gutierrez Lizarraga MA, Revert L. Prognostic value of spontaneous hyponatremia in cirrhosis with ascites. Am J Dig Dis 1976;21:249–256.
Llach J, Gines P, Arroyo V, et al. Prognostic value of arterial pressure, endogenous vasoactivc systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites. Gastroenterology 1988;94:482–487.
Salerno F, Borroni G, Moser P, et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol 1993;88:514–519.
Gines P, Uriz J, Calahorra B, et al. Transjugular intrahepatic portosystemic shunting versus repeated paracentesis plus intravenous albumin for refractory ascites in cirrhosis: a multicenter randomized comparative study. Gastroenterology 2002;123:1839–1847.
Gines P, Arroyo V, Vargas V, et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med 1991;325:829–835.
Sanyal AJ, Genning C, Reddy KR, et al. The North American Study for the Treatment of Refractory Ascites. Gastroenterology 2003;124:634–641.
Guardiola J, Baliellas C, Xiol X, et al. External validation of a prognostic model for predicting survival of cirrhotic patients with refractory ascites. Am J Gastroenterol 2002;97(9):2374–2378.
Gines A, Fernandez-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran-70 and poly gelinc in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002–1010.
Ruiz del Arbol L, Monescillo A, Jimenez W, Garcia-Plaza A, Arroyo V, Rodes J. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997;113:579–586.
Gines A, Escorsell A, Gines P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993;105:229–236.
Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet 2003;362(9398):1819–1827.
Howard TK. Postoperative intensive care management of the adult. In: Bussutil BW, Klintnialm GB, eds. Transplantation of the Liver. Saunders, Philadelphia, PA, 1996, pp. 551–563.
Urbani L, Catalano G, Cioni R, et al. Management of massive and persistent ascites and/or hydrothorax after liver transplantation. Transpl Proc 2003;35(4):1473–1475.
Cirera I, Navasa M, Rimola A, et al. Ascites after liver transplantation. Liver Transpl 2000;6(2):157–162.
Urbani L, Catalano G, Biancofiore G, et al. Surgical complications after liver transplantation. Minerva Chir 2003;58(5):675–692.
Leonardi LS, Boin IF, Leonardi MI, Tercioti V Jr. Ascites after liver transplantation and inferior vena cava reconstruction in the piggyback technique. Transpl Proc 2002;34(8):3336–3338.
Bilbao JI, Herrero JI, Martinez-Cuesta A, et al. Ascites due to anastomotic stenosis after liver transplantation using the piggyback technique: treatment with endovascular prosthesis. Cardiovasc Intervent Radiol 2000;23(2):149–151.
Urbani L, Catalano G, Cioni R, et al. Management of massive and persistent ascites and/or hydrothorax after liver transplantation. Transpl Proc 2003;35(4):1473–1475.
Adetiloye VA, John PR. Intervention for pleural effusions and ascites following liver transplantation. Pediatr Radiol 1998;28(7):539–543.
Asfar S, Lowndes R, Wall WJ. Chylous ascites after liver transplantation. Transplantation 1994;58(3):368–369.
Shapiro AM, Bain VG, Sigalet DL, Kneteman NM. Rapid resolution of chylous ascites after liver transplantation using somatostatin analog and total parenteral nutrition. Transplantation 1996;61(9):1410–1411.
Gane E, Langley P, Williams R. Massive ascitic fluid loss and coagulation disturbances after liver transplantation. Gastroenterology 1995;109(5):1631–1638.
Sebagh M, Blakolmer K, Falissard B, et al. Accuracy of bile duct changes for the diagnosis of chronic liver allograft rejection: reliability of the 1999 Banff schema. Hepatology 2002;35(1):117–125.
Nakazawa Y, Chisuwa H, Mita A, et al. Life-threatening veno-occlusive disease after living-related liver transplantation. Transplantation 2003;75(5):727–730.
Mor E, Fappo O, Bar-Nathan N, et al. Defibrotide for the treatment of veno-occlusive disease after liver transplantation. Transplantation 2001;72(7):1237–1240.
Starzl TE, Demetris AJ, Van Thiel D. Liver transplantation (2). N Engl J Med 1989;321:1092–1099.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Kbalid, S.K., Garcia-Tsao, G. (2005). Ascites. In: Sanyal, A.J., Shah, V.H. (eds) Portal Hypertension. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59259-885-4_19
Download citation
DOI: https://doi.org/10.1007/978-1-59259-885-4_19
Publisher Name: Humana Press
Print ISBN: 978-1-58829-386-2
Online ISBN: 978-1-59259-885-4
eBook Packages: MedicineMedicine (R0)