• Over 80% of patients with ascites have portal hypertension secondary to chronic liver diseases
• Less common causes are chylous, malignant, or pancreatic ascites
• Chylous ascites is most commonly due to occult tumor obstructing the lymphatic ducts (lymphoma or adenocarcinoma), external trauma, operative disruption, or congenital anomalies
• Malignant ascites occurs secondary to peritoneal implants stimulating ascitic fluid production or if there is advanced venous or lymphatic obstruction
• Vague, diffuse, constant abdominal discomfort associated with distention
• Ascites from cirrhosis associated with systemic signs of liver disease including palmar erythema, spider angiomas, gynecomastia, evidence of portosystemic shunting, and encephalopathy
• Malignant ascites associated with weight loss, a history of cancer, or symptoms related to the neoplasm (eg, fever, night sweats, and weight loss in cases of lymphoma)
• Chylous ascites often relatively asymptomatic with vague abdominal discomfort and mild abdominal distention
-Gradient > 1.1
-Grossly milky appearance
-Serum-ascites albumin gradient (SAAG) < 1.1
-Triglyceride level > 200 mg/dL
-Leukocyte count > 1000/µL
-Positive cytologic diagnosis
-Aneuploidy (flow cytometry)
-High lactic dehydrogenase (LDH) (> 500 IU/L)
-High carcinoembryonic antigen (CEA)
• Abdominal US verifies the presence of ascites, suggests the presence of liver disease, and guides diagnostic/therapeutic paracentesis
• Abdominal/pelvic CT scans are useful in documenting ascites; suggesting liver disease; detecting lymphadenopathy and masses of the mesentery as well as of solid organs, such as the liver, ovaries, and pancreas
• Portal hypertension
• Chylous ascites
• Malignant ascites
• Normal postoperative intra-abdominal fluid
• Sterile fluid collection
• Intra-abdominal abscess
• Soft-tissue neoplasm
• Chronic inflammatory peritonitis
• Diagnostic paracentesis: LDH level, albumin, amylase, triglyceride level, WBC count, cytologic studies, Gram stain, and culture
• Abdominal/pelvic CT scan:
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