Ascitis en el paciente no cirrótico
- Beatriz Burgueño Gomez 1
- I. Ruiz Núñez 1
- Elena Villacastin Ruiz 2
- Rebeca Pintado Garrido 2
- 1 Servicio de Aparato Digestivo, Hospital Universitario Río Hortega, Valladolid, España
- 2 Unidad de Radiología Vascular, Hospital Universitario Río Hortega, Valladolid, España
ISSN: 0304-5412
Year of publication: 2024
Issue Title: Enfermedades del aparato digestivo (XII) Patología peritoneal, portal y mesentérica
Series: 14
Issue: 12
Pages: 641-650
Type: Article
More publications in: Medicine: Programa de Formación Médica Continuada Acreditado
Abstract
Ascites, defined as the abnormal accumulation of fluid in the peritoneal cavity, is mainly due to cirrhosis and portal hypertension (PHT). However, in 20% of cases, it is not related to these diseases. Given its varied etiology, it is essential to study it in order to determine therapeutic management. The pathophysiology of non-cirrhotic ascites is not usually related to cirrhosis-associated PHT, and understanding these mechanisms facilitates the etiologic diagnosis. Symptoms include abdominal distension, weight gain, postprandial fullness, and even dyspnea. The physical examination may be normal in cases of very mild ascites. An increase in abdominal circumference may be identified in more advanced or severe cases and signs associated with the underlying disease may also appear. The International Club of Ascites classification categorizes it according to the amount and abdominal distension. The initial evaluation includes a medical history, physical examination, abdominal ultrasound, and ascitic fluid analysis. Diagnostic paracentesis is crucial for identifying the cause, analyzing characteristics of the fluid such as its appearance and content, especially the protein concentration and the serum ascites albumin gradient, which will allow differentiating the different causes. In Western countries, the most frequent causes are tumor and heart diseases while in developing countries, infectious diseases, especially tuberculosis, are the most prevalent.
Bibliographic References
- 1. P. Carrier et al. L’ascite non liée à la cirrhose: physiopathologie, diagnostic et étiologies [Non-cirrhotic ascites: pathophysiology, diagnosis and etiology] Rev Med Interne. (2014)
- 2. P. Baas et al. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial Lancet. (2021)
- 3. H. Eraksoy. Gastrointestinal and abdominal tuberculosis. Gastroenterol Clin North Am. (2021)
- 4. M.H. Su et al. Update on the differential diagnosis of gynecologic organ-related diseases in women presenting with ascites. Taiwan J Obstet Gynecol. (2019)
- 5. B.A. Runyon. Ascites and spontaneous bacterial peritonitis.
- 6. Santos Santamaría L, García-Pozuelo Adalia N. Ascitis. Manual de diagnóstico y terapéutica médica. 9ª ed. Madrid:...
- 7. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. (2010)
- 8. V. Arroyo et al. Ascites and spontaneous bacterial peritonitis.
- 9. L.J. Webb et al. The etiology, presentation and natural history of extra-hepatic portal venous obstruction. Q J Med. (1979)
- 9. S.W. Biggins et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases Hepatology. (2021)
- 10. S. Jang et al. Superiority of gastrojejunostomy over endoscopic stenting for palliation of malignant gastric outlet obstruction. Clin Gastroenterol Hepatol. (2019)
- 11. J.R. Mackey et al. Malignant ascites: demographics, therapeutic efficacy and predictors of survival. Can J Oncol. (1996)
- 12. D.G. Jayne et al. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. (2002)