Ascites

In summary, the diagnosis of ascites should be considered in all patients presenting with abdominal distention. A careful history and physical examination should be performed to rule out conditions that mimic ascites. Ultrasonography should be performed in questionable cases of ascites since physical examination and radiographic signs of ascites are unreliable. Paracentesis can help determine the etiology. Ascitic fluid should be examined to rule out spontaneous bacterial peritonitis, one of the few curable complications of cirrhosis. An ascitic fluid PMN count of greater than 250 per mm3 proves a sensitive indicator of infection. Medical treatment of cirrhotic ascites includes dietary sodium restriction and diuretics++. Large-volume paracentesis, with or without the use of colloid infusions, may provide useful adjunctive therapy. In rare instances, intractable ascites may be treated with a peritoneovenous shunt, although the complications and mortality rate of this procedure are significant. Peritoneovenous shunting, however, has not been shown to improve survival.