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ASCITES
PREPARED BY
Dr Zain Ul Abidin
Bahawal Victoria Hospital
Bahawalpur
Xe.zain@gmail.com
ASCITES
 Derived from the greek word “askos”, meaning bag or sac
 A condition of pathologic fluid accumulation within th...
Approach to the Patient with Ascites
Peritoneal Causes of Ascites:
1. Malignant ascites
Primary peritoneal mesotheloma
Sec...
Approach to the Patient with Ascites
3. Vasculitis
Systemic lupus erythematosus
Henoch-schonlein purpura
4. Miscellaneous ...
Approach to the Patient with Ascites
Non-Peritoneal Causes of Ascites:
1. Intrahepatic portal hypertension
Cirrhosis
Hepat...
Approach to the Patient with Ascites
3. Hypoalbuminemia
Nephrotic syndrome
Malnutrition
4. Miscellaneous disorder
myxedema...
Pathophysiology
1. Increased hydrostatic pressure
Cirrhosis
Hepatic vein occlusion
IVC obstruction
Cconstrictive pericardi...
Pathophysiology
3. Increase permeability of capillaries
Tuberculous peritonitis
Bacterial peritonitis
Malignant disease of...
HISTORY OF ASCITES
 Patients should be questioned regarding risk factors
for liver disease since cirrhosis is the most co...
HISTORY OF ASCITES
 Patients with ascites who lack risk factors for cirrhosis
should be questioned about cancer, heart fa...
Ascites
Ascites
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Ascites

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Ascites

  1. 1. ASCITES PREPARED BY Dr Zain Ul Abidin Bahawal Victoria Hospital Bahawalpur Xe.zain@gmail.com
  2. 2. ASCITES  Derived from the greek word “askos”, meaning bag or sac  A condition of pathologic fluid accumulation within the abdominal cavity which is a common complication in liver cirrhosis.  Healthy men: have little or no intraperitoneal fluid.  Healthy women: may have as much as 20ml of intraperitoneal fluid, depending on phase of menstrual cycle.
  3. 3. Approach to the Patient with Ascites Peritoneal Causes of Ascites: 1. Malignant ascites Primary peritoneal mesotheloma Secondary peritoneal Carcinomatosis 2. Granulomatous peritonitis Tuberculous peritonitis Fungal and parasitic infections Sarcoidosis Foreign bodies (cotton, starch, barium)
  4. 4. Approach to the Patient with Ascites 3. Vasculitis Systemic lupus erythematosus Henoch-schonlein purpura 4. Miscellaneous disorder Eosinophilic gastroenteritis Whipple disease Endometriosis
  5. 5. Approach to the Patient with Ascites Non-Peritoneal Causes of Ascites: 1. Intrahepatic portal hypertension Cirrhosis Hepatic failure Veno-Occlusive disease 2. Extrahepatic portal hypertension Hepatic vein obstruction Congestive heart failure
  6. 6. Approach to the Patient with Ascites 3. Hypoalbuminemia Nephrotic syndrome Malnutrition 4. Miscellaneous disorder myxedema Ovarian tumors Pancreatic & biliary ascites 5. Malignancy, Trauma
  7. 7. Pathophysiology 1. Increased hydrostatic pressure Cirrhosis Hepatic vein occlusion IVC obstruction Cconstrictive pericarditis Congestive heart failure 2. Decreased colloid osmotic pressure End stage liver disease Nephrotic syndrome with protein loss Malnutrition Protein-losing enteropathy
  8. 8. Pathophysiology 3. Increase permeability of capillaries Tuberculous peritonitis Bacterial peritonitis Malignant disease of the peritoneum 4. Leakage of fluid into the peritoneal cavity Bile ascites Pancreatic ascites Chylous ascites Urine ascites 5. Miscellaneous causes Myxedema Chronic hemodialysis
  9. 9. HISTORY OF ASCITES  Patients should be questioned regarding risk factors for liver disease since cirrhosis is the most common cause of ascites.  Risk factors for hepatitis C should be ruled out. such as needle sharing, tattoos, cocaine and heroin use.  Risk factors for hepatitis B should be rule out. such as needle sharing, tattoos and acupuncture  In patients with obesity, diabetes and hyperlipidemia, NASH should be ruled out.
  10. 10. HISTORY OF ASCITES  Patients with ascites who lack risk factors for cirrhosis should be questioned about cancer, heart failure, TB, dialysis and pancreatitis.  Operative injury to the ureter or bladder can lead to leakage of urine into peritoneal cavity.  Patients who are HIV+ may have unusual infections that lead to ascites formation.

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