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:

1. Transversely stretched umbilicus (laughing umbilicus)
2. Divarication of recti
3. Tense and shiny skin
4. Widened subcostal angle
5. 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