Ascites and Its Causes
Definition: Ascites is accumulation of fluid in the peritoneal cavity.
Diagnosis
Generalized distension of abdomen with more fullness in the flanks- Fluid thrill
- Horse-shoe-shaped and shifting dullness
- Other signs:
- Transversely stretched umbilicus (laughing umbilicus)
- Divarication of recti
- Tense and shiny skin
- Widened subcostal angle
- Lower ribs pushed outwards and upwards
Puddle sign
The patient is out in knee chest position so that the fluid gravitates down to the anterior abdominal wall. The stethoscope is placed over this and the anterior abdominal wall is flicked for a puddle sound.
Causes of Ascites
Transudates
1. Cardiac failure
2. Hypoproteinemia
3. Anemia
4. Beriberi
5. Nephrotic syndrome
6. Portal hypertension
7. Epidemic dropsy
8. Polyserositis
9. Meigs syndrome
Exudates
1. Peritoneal disease
a. Infections: Tuberculois, bacterial, fungal and parasitic infections
b. Neoplasms
2. Collagen disorders
3. Eosinophilic gastroenteritis
4. Gynecological: Endometriosis, struma ovarii
Miscellaneous
1. Pancreatic
2. Bile
3. Chylous
4. Myxedema
Mechanism of Ascites Prouction
1. Increased hydrostatic pressure intravascularly
2. Decreased osmotic pressure intravascularly due to hypoproteinemia
3. Increased osmotic pressure extravascularly
4. Increased lymphatic pressure
Causes of Hemorrhagic Fluid In Ascites
1. Trauma of thoracic duct
2. Parasite infections e.g. filariasis
3. Tuberculosis
4. Thrombosis of subclavian vein
5. Malignancy involving thoracic duct
Causes of Purulent Fluid Ascites
1. Abdominal infections
2. Penetrating would of abdomen
3. Pyemia and septicemia
4. Rupture or perforation of an organ
5. Ruptured amebic liver abscess
6. Pelvic inflammatory disease
Causes of Ascites Disporportionate to Edema of Feet
1. Cirrhosis of liver
2. Constrictive pericarditis
3. Restrictive cardiomyopathy
4. Hepatic venous occlusion
5. Tuberculous peritonitis
6. Intra-abdominal tumour