COMMENTARY

Management of Ascites

Rowen K. Zetterman, MD

Disclosures

April 05, 2011

In This Article

Ascites: Overview

Ascites is the pathologic collection of fluid within the peritoneal cavity and is often the result of cirrhosis of the liver.[1] Malignant disorders are the next most common cause. Ascites will develop within 10 years of diagnosis in 50% to 60% of patients with cirrhosis.[2] When ascites develops, a diagnostic paracentesis should be performed to evaluate the etiology of ascites and to look for spontaneous bacterial peritonitis (SBP).

Pathophysiology of Ascites

Ascites develops in cirrhosis from increased portal pressure within the liver, with transudation of fluid and proteins into the pace of Disse. When fluid accumulation exceeds the capacity of the lymphatic system to carry it away, fluid weeps from the hepatic surface into the peritoneal cavity. Sodium retention by the kidney contributes to ascites and may increase before the onset of ascites, in part because of renin-angiotensin-aldosterone system activation that enhances tubular reabsorption of sodium.[3]

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