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Management of Ascites: AJR Expert Panel Narrative Review
Joshua Cornman-Homonoff1, Brett E Fortune2, Kanti Pallav Kolli3
1Department of Radiology & Biomedical Imaging and Department of Medical Oncology, Yale School of Medicine, 330 Cedar St, Tompkin's East 2, New Haven, CT 06520.
AJR. American Journal of Roentgenology
|April 9, 2025
Summary
Accurate diagnosis of ascites, a fluid buildup in the abdomen, relies on fluid analysis. The serum-ascites-albumin gradient is key for determining the cause and guiding treatment for abdominal fluid accumulation.
Area of Science:
- Gastroenterology
- Internal Medicine
- Diagnostic Imaging
Background:
- Ascites, or abdominal fluid accumulation, arises from diverse medical conditions.
- Effective management necessitates identifying the underlying etiology.
- Fluid analysis, particularly the serum-ascites-albumin gradient (SAAG), is crucial for diagnosis.
Purpose of the Study:
- To offer evidence-based guidance on diagnosing and managing ascites.
- To clarify the role of fluid analysis in differentiating ascites causes.
- To review current treatment strategies for various ascites etiologies.
Main Methods:
- Review of existing literature and clinical evidence.
- Analysis of diagnostic fluid tests, emphasizing the SAAG.
- Discussion of therapeutic interventions for ascites.
Main Results:
- The SAAG is a primary tool for distinguishing between causes of ascites.
- Treatment varies from fluid removal (paracentesis, catheters) to targeted therapies (diuretics, shunts).
- Established guidelines exist for cirrhotic ascites, but management for other causes is less defined.
Conclusions:
- Accurate diagnosis through fluid analysis is paramount for effective ascites management.
- A range of treatments are available, tailored to the specific cause of ascites.
- Further clarification is needed for managing less common causes of ascites.
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