Abdominal Dropsy (Ascites): Or something else? Differential Diagnosis

Blood-forming organs-immune system (D50-D90).

  • Hereditary angioedema (HAE) – due to C1 esterase inhibitor (C1-INH) deficiency (blood protein deficiency); approximately 6% of cases:
    • Type 1 (85% of cases) – decreased activity and concentration of C1 inhibitor; autosomal dominant inheritance (new mutations about 25% of cases).
    • Type II (15% of cases) – decreased activity with normal or increased concentration of C1 inhibitor; expression of an abnormal C1-INH gene.

    Characterized by episodic skin and mucosal swelling, which may occur on the face and often on the extremities and gastrointestinal tract (gastrointestinal tract); furthermore, recurrent (recurrent) abdominal colic, acute ascites (abdominal dropsy) and edema (water retention), which occur up to twice a week and last for about 3-5 days if untreated.

Blood-forming organs – immune system (D50-D90).

  • Hereditary angioedema (HAE; obsolete “hereditary angioneurotic edema,” HANE) – due to C1 esterase inhibitor (C1-INH) deficiency (blood protein deficiency); approximately 6% of cases:
    • Type 1 (85% of cases) – decreased activity and concentration of C1 inhibitor.
    • Type II (15% of cases) – decreased activity with normal or increased concentration of C1 inhibitor.

    Characterized by episodic skin and mucosal swelling, which may occur on the face and often on the extremities and gastrointestinal tract, and the occurrence of acute ascites

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Hypalbuminemia – decreased albumin (protein) concentration in the blood.
  • Hypothyroidism (underactive thyroid gland)

Cardiovascular system (I00-I99)

  • Heart failure (cardiac insufficiency), severe
    • Right heart failure (3%)
  • Valvular heart disease – unspecified
  • Pericarditis constrictiva (Constrictive pericarditis) – the pericardium constricting form of pericarditis.
  • Portal vein thrombosis – thrombosis in the area of the portal vein circuit, which is connected between the liver, gastrointestinal tract, spleen and pancreas (pancreas).

Infectious and parasitic diseases (A00-B99).

Liver, gallbladder, and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Gallbladder rupture or perforation.
  • Hepatic vein thrombosis
  • Cirrhosis of the liver – irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with impairment of liver function (81%).
  • Leakage after biliary surgery
  • Pancreatic pseudocyst – formation of a false cyst in the area of the pancreas.
  • Pancreatitis (inflammation of the pancreas).
  • Pancreatic fistulas
  • Portal hypertension (portal hypertension; portal vein hypertension) → ascites formation always with conditioned by decreased renal sodium and water excretion

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Exudative enteropathy (protein loss enteropathy) – gastrointestinal disease in which there are large protein losses.

Neoplasms – tumor diseases (C00-D48) (10%).

  • CUP syndrome: Cancer of Unknown Primary (engl. ): cancer with unknown primary tumor (primarius): in about 3 to 5% of all tumor disease, despite extensive diagnostics, no primarius, but only metastasis (formation of daughter tumors) can be determined (in approx. 20% of cases with malignant ascites / malignant abdominal dropsy the primary tumor remains unknown)autopsy studies can detect the primarius in 50 to 85% of cases, this is found in 27% of cases in the lungs, in 24% in the pancreas (pancreas), and less frequently in liver / biliary tract, kidney, adrenal gland, colon, genital organs and stomach; histologically (fine tissue) it is mostly adenocarcinomas
  • Bronchial carcinoma (lung cancer).
  • Endometrial carcinoma (cancer of the uterus)
  • Gastrointestinal tumors (gastrointestinal tumors).
  • Hepatocellular carcinoma (HCC; hepatocellular carcinoma).
  • Colon carcinoma (colon cancer)
  • Liver metastases
  • Malignant lymphoma (malignant neoplasm originating from lymphoid cells).
  • Gastric carcinoma (approximately 18% of all patients with malignant ascites).
  • Mammary carcinoma (breast cancer)
  • Mucinous cystadenoma (benign (benign) ovarian tumor/ovarian tumor; usually unilateral; women between the 3rd and 5th decade of life).
  • Ovarian cancer (ovarian cancer) (about 37% of all patients with malignant ascites).
  • Pancreatic cancer (pancreatic cancer) (pancreatobiliary system 21% of all patients with malignant ascites).
  • Peritoneal carcinomatosis – diffuse metastases in the peritoneal area (peritoneum).
  • Pseudomyxoma peritonei (biliary abdomen).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Meigs syndrome – benign (benign) tumor of the ovaries (ovary) associated with ascites (abdominal fluid) and hydrothorax (accumulation of water in the chest).
  • Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include: Proteinuria (increased excretion of protein in the urine) with a protein loss of more than 1 g/m²/body surface per day; Hypoproteinemia, peripheral edema due to hypalbuminemia of < 2.5 g/dl in serum, hyperlipoproteinemia (lipid metabolism disorder).

Medications

  • Dihydropyridine-type calcium antagonists, such as amlodipine, lercanidipine, manidipine, nisoldipine, nitrendipine, or nifedipine, especially in peritoneal dialysis patients; occurrence of chylous ascites in up to 13% of cases

Further

  • Dialysis (blood washing) (1%)
  • Obstruction (narrowing) of the lymphatic channels due to tumors, trauma (injury), malformation, or metastases (daughter tumors)