lascite

Lascite, or ascites, is the abnormal accumulation of fluid within the peritoneal cavity. It is most commonly caused by liver cirrhosis but can arise from congestive heart failure, malignancy, infections (including spontaneous bacterial peritonitis), nephrotic syndrome, or pancreatitis.

Pathophysiology: In cirrhosis, portal hypertension and reduced hepatic albumin production lower plasma oncotic pressure and promote sodium and water retention. These changes, together with splanchnic vasodilation and activation of neurohumoral systems, drive fluid into the peritoneal space.

Diagnosis: Clinically, ascites causes abdominal distension and shifting dullness. Ultrasound confirms fluid and guides paracentesis. Ascitic fluid analysis uses the serum-ascites albumin gradient (SAAG); SAAG ≥ 1.1 g/dL indicates portal hypertension. Additional tests assess infection (cell count, culture) and malignancy (cytology).

Management: Address the underlying cause and reduce fluid accumulation. Lifestyle measures include sodium restriction. Pharmacologic therapy uses diuretics—spironolactone as first line, often with furosemide in a fixed ratio. Large-volume paracentesis provides rapid relief; albumin infusion reduces circulatory dysfunction. Refractory ascites may require transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation. Spontaneous bacterial peritonitis prophylaxis is considered in high-risk patients.

Prognosis: The development of ascites reflects advanced disease and is associated with reduced survival; prognosis depends on the underlying condition and response to treatment.