Ascites

  • Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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What are the types of ascites?

Traditionally, ascites is divided into 2 types; transudative or exudative. This classification is based on the amount of protein found in the fluid.

A more useful system has been developed based on the amount of albumin in the ascitic fluid compared to the serum albumin (albumin measured in the blood). This is called the Serum Ascites Albumin Gradient or SAAG.

  • Ascites related to portal hypertension (cirrhosis, congestive heart failure, Budd-Chiari) is generally greater than 1.1.
  • Ascites caused by other reasons (malignant, pancreatitis) is lower than 1.1.

What are the risk factors for ascites?

The most common cause of ascites is cirrhosis of the liver. Many of the risk factors for developing ascites and cirrhosis are similar. The most common risk factors include hepatitis B, hepatitis C, and long standing alcohol abuse. Other potential risk factors are related to the other underlying conditions, such as congestive heart failure, malignancy, and kidney disease.

What are the symptoms of ascites?

There may be no symptoms associated with ascites especially if it is mild (usually less than about 100 – 400 ml in adults). As more fluid accumulates, increased abdominal girth and size are commonly seen. Abdominal pain, discomfort, and bloating are also frequently seen as ascites becomes larger. Shortness of breath can also happen with large ascites due to increased pressure on the diaphragm and the migration of the fluid across the diaphragm causing pleural effusions (fluid around the lungs). A cosmetically disfiguring large belly, due to ascites, is also a common concern of some patients.

Medically Reviewed by a Doctor on 2/24/2016
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