Ascites causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2], Carlos A Lopez, M.D. [3], Eiman Ghaffarpasand, M.D. [4]

Overview

Ascites is a gastroenterological term for an excess accumulation of fluid in the peritoneal cavity. Life threatening causes are acute liver failure, hepatic failure, and hepatorenal syndrome. Common causes are Budd-Chiari syndrome, malignancy, and cirrhosis.

Causes

Life Threatening Causes

• Acute liver failure
• Hepatic failure
• Hepatorenal syndrome
• Liver fibrosis
• Liver cirrhosis

Common Causes

• Budd-Chiari syndrome
• Cancer
• Cirrhosis
• Constrictive pericarditis
• Heart failure
• Nephrotic syndrome
• Pancreatitis
• Serositis
• Tuberculosis

Less common causes

Causes of fetal ascites

• Gastrointestinal disorders
  • Meconium peritonitis
  • Intestinal malrotation
  • Small intestinal or colonic atresia
  • Intussusception
  • Volvulus
  • Cystic fibrosis
  • Biliary atresia
  • Portal venous malformations
• Infection
  • Parvovirus
  • Syphilis
  • Cytomegalovirus
  • Toxoplasmosis
  • Acute maternal hepatitis
• Genitourinary disorders
  • Hydronephrosis
  • Polycystic kidney disease
  • Urinary obstruction
  • Ovarian cyst
  • Persistent cloaca
• Chylous ascites
• Cardiac disorders
  • Arrhythmia
  • Heart failure
• Chromosomal abnormalities
  • Trisomy
  • Turner syndrome
• Neoplasm
• Hematologic
  • Hemolytic anemia
  • Neonatal hemochromatosis
• Metabolic disease
  • Niemann-Pick type C
  • Congenital disorders of glycosylation
  • Wolman disease
  • Lysosomal storage disease
• Other
  • Maternal/fetal abuse
  • Idiopathic

Causes of neonatal ascites

• Hepatobiliary disorders
  • Cirrhosis
  • Alpha-1-antitrypsin deficiency
  • Congenital hepatic fibrosis
  • Viral hepatitis
  • Budd-Chiari syndrome
  • Biliary atresia
  • Bile duct perforation
  • Portal venous malformation
  • Ruptured mesenchymal hamartoma
• Gastrointestinal disorders
  • Intestinal malrotation
  • Intestinal perforation
  • Acute appendicitis
  • Intestinal atresia
  • Pancreatitis
• Chylous ascites
• Parenteral nutrition extravasation
• Metabolic disease
• Genitourinary disorders
  • Obstructive uropathy
    • Posterior urethral valves
    • Ureterocele
    • Lower ureteral stenosis
    • Ureteral atresia
    • Imperforate hymen
    • Bladder rupture
  • Bladder injury from umbilical artery catheterization
  • Nephrotic syndrome
  • Ruptured corpus luteum cyst
• Cardiac
  • Arrhythmia
  • Heart failure
• Hematologic
  • Neonatal hemochromatosis
• Other
  • Cutis marmota telangictatica congenita
  • Intravenous vitamin E
  • Pseudo-ascites
    • Small bowel duplication
  • Abdominal trauma
  • Idiopathic

Causes of infants and children

• Hepatobiliary disorders
  • Cirrhosis
  • Congenital hepatic fibrosis
  • Acute hepatitis
  • Budd-Chiari syndrome
  • Bile duct perforation
  • Liver transplantation
• Gastrointestinal disorders
  • Acute appendicitis
  • Intestinal atresia
  • Pancreatitis
  • Pyloric duplication
• Serositis
  • Crohn disease
  • Eosinophilic enteropathy
  • Henoch-Schonlein purpura
• Chylous ascites
  • Intestinal lymphangiectasia
  • Lymphatic duct obstruction
  • Lymphatic duct trauma
• Parenteral nutrition extravasation
• Neoplasm
  • Lymphoma
  • Wilm tumor
  • Clear cell renal sarcoma
  • Glioma
  • Germ cell tumor
  • Ovarian tumor
  • Mesothelioma
  • Neuroblastoma
• Metabolic disease
• Genitourinary disorders
  • Nephrotic syndrome
  • Peritoneal dialysis
• Cardiac
  • Heart failure
• Pseudo-ascites
  • Celiac disease
  • Cystic mesothelioma
  • Omental cyst
  • Ovarian cyst
• Other
  • Systemic lupus erythematosus
  • Ventriculoperitoneal shunt
  • Vitamin A toxicity
  • Chronic granulomatous disease
  • Nonaccidental trauma
  • Idiopathic

Causes by Organ System

Cardiovascular	Arteriovenous fistula, Budd-Chiari syndrome, Cardiac amyloidosis, Cardiomegaly, Cardiomyopathy, Cholesterol pericarditis, Congestive heart failure, Constrictive pericarditis, Congestive heart failure, Constrictive pericarditis, Tuberculous pericarditis, Chylous ascites, Cor pulmonale, Diffuse neonatal hemangiomatosis, Endomyocardial fibrosis, Heart failure, Inferior vena cava web, Lymphatic obstruction, Lymphangioma, Kaposiform hemangio-endothelioma, Inferior vena cava syndrome, Pericarditis, Right heart failure, Tricuspid insufficiency, Tricuspid regurgitation, Tricuspid stenosis, Tricuspid valve disease, Veno-occlusive disease, Ventriculoperitoneal shunt, Waldmann disease.
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acyclovir, Mercaptopurine, Pramipexole, Thalidomide
Ear Nose Throat	No underlying causes
Endocrine	Hypothyroidism, Thyroxine deficiency, Ovarian hyperstimulation syndrome
Environmental	No underlying causes
Gastroenterologic	Acute liver failure, Acute pancreatitis, Alcoholic hepatitis, Alcoholic liver disease, Ascending cholangitis, Biliary atresia, Biliary fistula, Budd-Chiari syndrome, Cholangiocarcinoma, Cholecystitis, Cholelithiasis, Chronic hepatitis,Cirrhosis, Colorectal cancer, Congenital liver fibrosis, End stage liver failure, Eosinophilic gastroenteritis, Esophageal cancer, Fitz-Hugh-Curtis syndrome, Fulminant liver failure, Granulomatous peritonitis, Hemochromatosis, Hepatic failure, Hepatic venoocclusive disease with immunodeficiency, Hepatitis, Hepato-biliary diseases, Idiopathic liver cirrhosis, Krukenberg tumor, Liver cancer, Liver damage, Ménétrier's disease, Mosse syndrome, Neonatal hepatitis, Nodular regenerative hyperplasia of the liver, Nutmeg liver, Obliterative portal venopathy, Obstructive jaundice, Pancreatic cancer, Pancreatic fistula, Peritonitis, Portal hypertension, Portal vein occlusion, Portal vein thrombosis, Primary biliary cirrhosis, Primary sclerosing cholangitis, Pseudomyxoma peritonei, Secondary biliary cirrhosis, Severe hepatitis, Stomach cancer, Tuberculous peritonitis, Waldmann disease, Whipple disease
Genetic	No underlying causes
Hematologic	Angioimmunoblastic T-cell lymphoma, Banti's Syndrome, Budd-chiari syndrome, Diffuse neonatal hemangiomatosis, Eosinophilic gastroenteritis, Erythroblastosis fetalis , Extramedullary haemopoiesis, Hemolytic disease of the newborn, Mastocytosis, Mosse syndrome, Tang Hsi Ryu syndrome
Iatrogenic	No underlying causes
Infectious Disease	Alveolar hydatid disease, Amebiasis, Bilharzia, Chronic hepatitis, Chronic viral hepatitis, cytomegalovirus, Echinococcosis, Epstein Barr virus, Filariasis, Fitz-Hugh-Curtis syndrome, acute hepatitis A, Acute hepatitis B, Acute hepatitis C, Acute Hepatitis D, Acute hepatitis E, Herpes simplex infection, Hookworm disease, Kaposiform hemangio-endothelioma, Leptospirosis, Malaria, Portal hypertension in schistosomiasis, Poststreptococcal glomerulonephritis, Rubella virus infection,Schistosomiasis, Hepatosplenic schistosomiasis, Sleeping sickness, Strongyloidiasis, Stuartbras disease, liver disease in syphilis, Toxoplasmosis, Tuberculosis, Tuberculous peritonitis, Tularemia, Whipple disease, Yellow fever virus infection
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Crigler-Najjar syndrome, Dubin-Johnson syndrome, Gilbert's syndrome, Hemochromatosis, Hypoalbuminemia, Kwashiorkor, Rotor's syndrome, VLCAD deficiency, Wilson's Disease
Obstetric/Gynecologic	Meigs' syndrome, Mirror syndrome
Oncologic	Anasarca, Angioimmunoblastic T-cell lymphoma, Angiosarcoma of the liver, Bladder cancer, Cholangiocarcinoma, Cirrhosis of liver, Colorectal cancer, Desmoplastic small round cell tumor, Esophageal cancer, Liver cancer, Liver cirrhosis, Lung cancer, Meig's syndrome, Metastasis, Ovarian cancer, Pancreatic cancer, Pelvic region cancers, Pseudomyxoma peritonei, Stomach cancer, WAGR syndrome, Wilms tumor, Yolk sac tumor,
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Cor pulmonale, Lung cancer, Mesothelioma, Nephrotic syndrome, Pulmonary hypertension
Renal / Electrolyte	Hepatorenal syndrome, Nephrotic syndrome
Rheum / Immune / Allergy	Chronic bacterial infection, Erythroblastosis fetalis, Eosinophilic gastroenteritis, Eosinophilic peritonitis, Hemolytic disease of the newborn, Hemolytic anemia, Hepatic venoocclusive disease with immunodeficiency, Hepatoma, Immunoproliferative diseases, Primary biliary cirrhosis, Systemic lupus erythematosus
Sexual	No underlying causes
Trauma	Bladder rupture
Urologic	No underlying causes
Miscellaneous	Hypervolemia, Idiopathic, Metastasis, Obesity hypoventilation syndrome, POEMS syndrome

Causes in Alphabetical Order

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Fetal Ascites

Causes of fetal ascites include:

• Urinary ascites
• Bowel rupture (i.e. meconium peritonitis)
• Ruptured ovarian cyst
• Hydrops
• Pseudoascites
• Infection