Ascites

Abstract

Ascites is the pathological accumulation of fluid in the abdominal cavity caused by an imbalance of fluid in and out of the blood and lymphatic vessels. Portal hypertension is the major cause of ascites, but infectious and malignant causes are also very important. Cancer induced ascites is present in about 10% of all patients. Palliation of ascites is vital for holistic patient management. Median survival after diagnosis of malignant ascites was only 20 weeks from the time of diagnosis of ascites, except for tumors of ovarian and lymphatic origin, which have better mean survivals (32 and 58 weeks, respectively). The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach, and pancreas. The cancer type largely influences the sites of abdominal metastases and the cause of the ascites. The manifestation of symptoms depends on the amount of fluid, rapidity of fluid accumulation, and the cause of ascites. Patients often first seek medical attention because of abdominal discomfort, pain, breathing difficulty, or early satiety. They may also complain of reduced appetite, nausea, vomiting, lower extremity edema, weight gain, and reduced mobility. The diagnosis is based upon the clinical setting, imaging tests, and ascitic fluid analysis. Radiologic studies are useful in detecting small amounts of ascitic fluid as well as helpful in assessing the etiology of ascites. Ultrasonography is the commonest and most convenient investigation for diagnosing ascites. Depending on the clinical setting, computed tomography or magnetic resonance imaging scans are excellent investigations. The detection of tumor cells by cytology remains the gold standard for the detection of malignancy. In most instances, the treatment of metastatic cancer with ascites is palliative. Treatment options include large-volume paracentesis, peritoneovenous shunting, drainage catheters, surgery, intraperitoneal therapy, and tumor-targeted treatment.