ascitesissä

Ascites is the accumulation of fluid in the peritoneal cavity. The condition may result from a variety of underlying disorders, most commonly liver disease such as cirrhosis, congestive heart failure, renal failure, malignancy, infection, or portal hypertension. The fluid buildup distends the abdomen, causing swelling, pain, and sometimes respiratory difficulty. Ascitic fluid is typically clear, pale yellow, and mildly alkaline.

diagnosis of ascites relies on clinical examination and imaging such as ultrasound. Paracentesis, the therapeutic removal of fluid, is both diagnostic and therapeutic. The fluid is analyzed for cell count, protein level, albumin, total bilirubin, lactate dehydrogenase, microbiology, and cytology. A serum‑ascites albumin gradient (SAAG) greater than 1.1 g/dL indicates portal hypertension as the cause, whereas a lower SAAG suggests other etiologies. Cytology is required to rule out malignant cells in patients with cancer or ascites of unknown origin.

Management of ascites addresses the underlying disease. In portal hypertension, diuretics such as spironolactone with a low dose furosemide are first‑line therapy to reduce sodium and water retention. Fluid restriction to 1–1.5 liters per day is also customary. Large-volume paracentesis is indicated for tense ascites or when diuretics are ineffective. Recurrent paracentesis may be combined with intravenous albumin to maintain circulatory stability. Transjugular intrahepatic portosystemic shunt (TIPS) or surgical shunt procedures are considered when maximal medical therapy fails. For ascites secondary to malignancy or infection, treating the underlying malignancy or eradicating infection with antibiotics is essential.

Prognosis depends on the root cause. Refractory ascites in cirrhosis indicates a poor long‑term outlook, but early intervention can prolong survival. In patients with heart failure or renal disease, timely management can improve symptoms and quality of life. Early recognition, accurate diagnosis, and appropriate treatment of the underlying disorder are key to controlling ascites and reducing complications.