Ascitic

Ascitic is an adjective meaning relating to ascites, the abnormal accumulation of fluid within the peritoneal cavity. In medical use, ascitic typically describes fluid accumulation or the fluid itself detected in diagnostic or therapeutic procedures. Ascites most commonly arises from cirrhosis with portal hypertension but can also occur with congestive heart failure, malignancy, pancreatitis, nephrotic syndrome, infections, or malnutrition.

Clinical features include abdominal distension, a sense of fullness, and, if substantial, shortness of breath. Evaluation begins with history and examination, followed by imaging such as ultrasound to confirm fluid and to assess for underlying causes. Diagnostic paracentesis provides ascitic fluid for analysis, including cell count, protein concentration, albumin, culture, and cytology. The serum-ascites albumin gradient (SAAG) helps differentiate portal-hypertension–related ascites (SAAG ≥ 1.1 g/dL) from non-portal-hypertension causes (SAAG < 1.1). Fluid protein levels and other tests aid further classification and management.

Pathophysiology typically involves imbalances in hydrostatic and oncotic pressures within the peritoneal capillaries, compounded by neurohumoral activation that promotes sodium and water retention. Management focuses on treating the underlying disease and controlling fluid accumulation. General measures include sodium restriction and diuretics (often spironolactone with or without furosemide). Large-volume paracentesis provides rapid symptom relief; albumin infusion may be used to prevent circulatory dysfunction after drainage. Refractory ascites may be addressed with transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation when appropriate. In cancer-related ascites, oncologic therapy or palliative drainage may be utilized.

Prognosis depends on etiology and overall organ function; ascites is a marker of advanced disease in conditions like cirrhosis and is associated with significant morbidity.