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Ascites is the abnormal build- Up of fluid in the peritoneal cavity.
Most common cause- Cirrhosis 80%
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Type of Ascites-
Ascites exists in three grades:
Grade 1: Up to 150ml Mild, only visible on ultrasound and CT
Grade 2: 1500-2000ml Detectable with flank bulging and shifting dullness
Grade 3: more than 2000ml directly visible, confirmed with the fluid wave/thrill test
Symptoms-
Mild ascites is hard to notice, but severe ascites leads to respiratory embarrassment.
Gradual distension
Progressive abdominal heaviness and pressure.
Shortness of breath.
Risk of spontaneous bacterial peritonitis.
Signs
Puddle sign- in mild
Shifting dullness- in moderate difference in percussion note in the flanks that shifts when the person is turned on the side
Fluid thrill- in severe tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen.
Tanyol sign-
Umbilicus shifted upward- pelvic swelling ex-ovarian cyst
Umbilicus shifted downward- ascites
Smiling horizontal umbilicus
Other signs of ascites may be present due to its underlying cause.
Portal hypertension perhaps due to cirrhosis or fibrosis of the liver
Leg swelling
Bruising
Gynecomastia
Hematemesis
Mental changes due to Encephalopathy
Investigation
Complete blood count CBC
Basic metabolic profile
Liver enzymes and coagulation
Diagnostic paracentesis
Additional tests- such as microbiological culture, Gram stain and cytopathology.
The serum-ascites albumin gradient SAAG -
A high gradient more than 1.1 g/dL indicates the ascites is due to portal HTN.
A low gradient lower than1.1 g/dL indicates ascites of non-portal HTN as a cause.
Ultrasound
Doppler studies
Abdominal CT scan more accurate
CT scan- 80ml
USG- 100ml
Puddle sign- 150 ml
Shifting dullness- 1-1.5 lt.
Horse shoe dullness- 2-3 lt.
Fluid thrill method- more then 3 lt