Ascites

Abstract

Large amounts of ascitic fluid may cause distention, weight gain, anorexia and nausea. Smaller accumulations may be asymptomatic and difficult to detect clinically. Ultrasound examination is useful in establishing the diagnosis and in locating the optimal site for paracentesis. Calculation of the serum-ascites albumin gradient provides useful diagnostic information. High gradients usually indicate portal hypertension, while low gradients may indicate infection or carcinomatosis. Management is directed toward alleviating the underlying cause of ascites and reducing symptoms. Initially restriction of salt intake to 2 mEq/kg per day is usually advised. Most patients require diuretic therapy. Spironolactone, the usual first-choice agent, may be combined with furosemide in selected patients. If diuretic therapy is unsuccessful, therapeutic paracentesis, peritoneovenous portosystemic shunting, transjugular intrahepatic shunting or liver transplantation may be required.