Definition

• Pathological accumulation of fluid in peritoneal cavity

Types

• Transudative
• Exudative

Causes

Cause of fetal ascites

• GI - intestinal obstruction : malrotation, intusseception, atresia of intestines, volulus, biliary atresia
• Genitourinal diseases - hydronephrosis, PCKD, urinary obstruction
• Cardiac - Heart failure, arryhthmias
• Metabolic - niemann pick type C, lysosomal storage diesasees
• Chylous - lymphangiectasia
• infections - syphilis, cytomegalovirus, toxoplasmosis
• hematological - hemolytic anemia, hemochromatosis
• chromotomal abnormalitis

Causes of neonatal ascites

• hepatobiliary - biliary atresia, viral hepatitis, budd chiari, congenital hepatic fibrosis
• genitourinary - Posterior urethral valve, ureterocele, rupture of bladder, nephrotic syndrome
• GI - atresia, malrotation
• hematological - neonatal hemochromatosis
• Cardiac - Heart failure, arryhthmias
• metabolic - mucopolysaccharidosis VIII
• idiopathic

Caused of childhood ascites

• hepatobiliary - cirrhosis with chronic liver disease, acute hepatitis, budd chairi, congenital hepatic fibrosis
• GI - intestinal atresia, pancreatitis, appendicitis
• serositis - IBD, eosinophilic enteritis
• neoplasms - wilms tumor, mesothelioma, lymphoma, germ cell malignancies
• cardiac disease - heart failure
• pseudo ascities - ovarian cyst, celiac disease, mesothelioma
• genetourinary - nephrotic syndrome
• chylous ascites - lymph duct obstruction, intestinal lymphangiectasia

Signs

• puddle sign
• flank fullness
• dullness to percussion
• shifting dullness
• umblical herniation

Diagnosis

• USG abdomen
• paracentesis - diagnostic and therapeutic
• SAAG gradient - serum albumin - ascites albumin
  • more than 1.1 - portal HTN
  • less than 1.1 - non portal HTN

Treatment

• treat etiology
• General management
  • dietary sodium restriction
  • spirinolactone
  • furosemide in severe cases
  • supplemental albumin
  • TIPS (Transjugular Intrahepatic portosystemic shunt)
• manage SBP