Ascites: Pathophysiology, diagnosis and treatment

Abstract

Ascites is the accumulation of fluid in the peritoneal cavity, caused by a wide variety of entities, the most common is liver cirrhosis. In these patients, the development of ascites is the consequence of splanchnic vasodilation, a decrease in the effective circulating volume and activation of the sympathetic nervous system and the renin angiotensinaldosterone system, in addition to a systemic inflammatory process. The diagnostic approach includes, in addition to clinical data suggestive of ascites and its specific causes, imaging studies (abdominal ultrasound is the initial method of choice, and can be complemented with tomography or magnetic resonance imaging) and laboratory studies, such as the serum-ascitic albumin gradient (which allows the distinction between causes related to portal hypertension versus oncological, infectious and other inflammatory ones, nephrotic syndrome, etc.), stains, cultures and cytology, among others. Some molecular biomarkers are under investigation. Management is diverse and depends on the specific cause.