Definition
- Pathological accumulation of fluid in peritoneal cavity
Types
- Transudative
- Exudative
Causes
Cause of fetal ascites
- GI - intestinal obstruction : malrotation, intusseception, atresia of intestines, volulus, biliary atresia
- Genitourinal diseases - hydronephrosis, PCKD, urinary obstruction
- Cardiac - Heart failure, arryhthmias
- Metabolic - niemann pick type C, lysosomal storage diesasees
- Chylous - lymphangiectasia
- infections - syphilis, cytomegalovirus, toxoplasmosis
- hematological - hemolytic anemia, hemochromatosis
- chromotomal abnormalitis
Causes of neonatal ascites
- hepatobiliary - biliary atresia, viral hepatitis, budd chiari, congenital hepatic fibrosis
- genitourinary - Posterior urethral valve, ureterocele, rupture of bladder, nephrotic syndrome
- GI - atresia, malrotation
- hematological - neonatal hemochromatosis
- Cardiac - Heart failure, arryhthmias
- metabolic - mucopolysaccharidosis VIII
- idiopathic
Caused of childhood ascites
- hepatobiliary - cirrhosis with chronic liver disease, acute hepatitis, budd chairi, congenital hepatic fibrosis
- GI - intestinal atresia, pancreatitis, appendicitis
- serositis - IBD, eosinophilic enteritis
- neoplasms - wilms tumor, mesothelioma, lymphoma, germ cell malignancies
- cardiac disease - heart failure
- pseudo ascities - ovarian cyst, celiac disease, mesothelioma
- genetourinary - nephrotic syndrome
- chylous ascites - lymph duct obstruction, intestinal lymphangiectasia
Signs
- puddle sign
- flank fullness
- dullness to percussion
- shifting dullness
- umblical herniation
Diagnosis
- USG abdomen
- paracentesis - diagnostic and therapeutic
- SAAG gradient - serum albumin - ascites albumin
- more than 1.1 - portal HTN
- less than 1.1 - non portal HTN
Treatment
- treat etiology
- General management
- dietary sodium restriction
- spirinolactone
- furosemide in severe cases
- supplemental albumin
- TIPS (Transjugular Intrahepatic portosystemic shunt)
- manage SBP