hepatic and biliary disorders
Ascites
Key Points
Ascites is free fluid in the abdominal cavity, usually caused by portal hypertension and sometimes by other hepatic or nonhepatic conditions. Moderate amounts of fluid can increase abdominal girth and cause weight gain, and massive amounts can cause abdominal distention, pressure, and dyspnea; signs may be absent if fluid accumulation is<1500 mL. Unless the diagnosis is obvious, confirm the presence of ascites using ultrasonography or CT. If ascites is newly diagnosed, its cause is unknown, or spontaneous bacterial peritonitis is suspected, do paracentesis and test ascitic fluid. Recommend dietary sodium restriction; if insufficiently effective, consider use of diuretics and therapeutic paracentesis. Promptly refer patients with refractory ascites for liver transplantation. 