Ascites classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Ascites may be classified according to etiology into four groups include: portal hypertension associated, hypoalbuminemia associated, peritoneal disease associated, and other diseases associated. Ascites is also classified based on the serum-ascites albumin gradient (SAAG) as two subtypes include transudate - SAAG > 1.1 g/dL and exudate - SAAG < 1.1 g/dL.

Classification

Ascites may be classified according to etiology into four groups:[1]

Ascites is also classified based on the serum-ascites albumin gradient (SAAG) as two subtypes:[2]

 
 
 
 
 
 
 
 
 
 
 
 
 
Ascites classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on Etiology
 
 
 
 
 
 
 
 
 
 
Based on SAAG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Portal hypertension
 
Hypoalbuminemia
 
Peritoneal disease
 
Other etiologies
 
 
High (SAAG > 1.1 g/dL)
 
Low (SAAG < 1.1 g/dL)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cirrhosis
Alcoholic hepatitis
Acute liver failure
Hepatic veno-occlusive disease
Heart failure
Constrictive pericarditis
Hemodialysis-associated
 
Nephrotic syndrome
Protein-losing enteropathy
• Severe malnutrition
 
Malignant ascites
• Infectious peritonitis
Eosinophilic gastroenteritis
• Starch granulomatous peritonitis
Peritoneal dialysis
• Multicystic mesothelioma (peritoneal inclusion cyst)
 
Chylous ascites
Pancreatic ascites
Myxedema
Hemoperitoneum
Urologic injury
 
 
Cirrhosis
Fulminant hepatic failure
• Veno-occlusive disease
Hepatic vein obstruction (i.e., Budd-Chiari syndrome)
Congestive heart failure
Nephrotic syndrome
Protein-losing enteropathy
Malnutrition
Myxedema
Ovarian tumors
Pancreatic ascites
Biliary ascites
Malignancy
Trauma
Portal hypertension
 
• Primary peritoneal mesothelioma
• Secondary peritoneal carcinomatosis
Tuberculous peritonitis
Fungal and parasitic infections (eg, Candida, Histoplasma, Cryptococcus, Schistosoma mansoni, Strongyloides, Entamoeba histolytica)
Sarcoidosis
Foreign bodies (i.e., talc, cotton and wood fibers, starch, barium)
Systemic lupus erythematosus
Henoch-Schönlein purpura
Eosinophilic gastroenteritis
Whipple disease
Endometriosis


References

  1. Moore KP, Aithal GP (2006). "Guidelines on the management of ascites in cirrhosis". Gut. 55 Suppl 6: vi1–12. doi:10.1136/gut.2006.099580. PMC 1860002. PMID 16966752.
  2. Hou W, Sanyal AJ (2009). "Ascites: diagnosis and management". Med. Clin. North Am. 93 (4): 801–17, vii. doi:10.1016/j.mcna.2009.03.007. PMID 19577115.



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