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Ascites in Children.

Ashish Bavdekar1, Nitin Thakur2

  • 1Department of Pediatrics, KEM Hospital Research Centre, Rasta Peth, Pune, Maharashtra, 411 011, India. bavdekar@vsnl.com.

Indian Journal of Pediatrics
|June 10, 2016
PubMed
Summary
This summary is machine-generated.

Ascites, fluid in the abdomen, often complicates liver cirrhosis. Diagnosis involves paracentesis and SAAG measurement, while treatment includes diuretics, salt restriction, or paracentesis for children.

Keywords:
AscitesChildCirrhosisDiagnosisManagement

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Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Nephrology

Background:

  • Ascites is abdominal fluid accumulation, a frequent liver cirrhosis complication.
  • Hepatic, renal, and cardiac issues are primary causes in children.
  • Pathophysiology involves portal hypertension and fluid/sodium retention, driven by vasodilation.

Purpose of the Study:

  • To outline the pathophysiology, diagnosis, and management of ascites in children.
  • To emphasize diagnostic paracentesis and SAAG's role in classification.
  • To detail treatment strategies based on ascites severity and underlying cause.

Main Methods:

  • Review of ascites pathophysiology, diagnostic criteria, and therapeutic options in pediatric populations.
  • Diagnostic paracentesis for fluid analysis (cell count, protein, culture).
  • Serum-ascites albumin gradient (SAAG) calculation for classifying ascites (portal hypertensive vs. non-portal hypertensive).

Main Results:

  • SAAG >1.1 g/dL indicates portal hypertension; SAAG <1.1 g/dL suggests non-portal hypertensive causes.
  • Neutrophil count ≥250 cells/mm³ strongly suggests bacterial peritonitis.
  • Treatment varies: underlying condition for non-liver disease; diuretics/salt restriction for mild-moderate liver ascites.

Conclusions:

  • Ascites management in children requires accurate diagnosis via paracentesis and SAAG.
  • Diuretics, salt restriction, and fluid management are key for mild-moderate cases.
  • Refractory ascites may necessitate large volume paracentesis, shunts, or liver transplantation.