Ascites – colloquially called abdominal dropsy – (synonym: ascites; ICD-10-GM R18: ascites) is a pathological (pathological) accumulation of water in the abdominal cavity.This can be caused by many different diseases. In about 80% of all cases, the occurrence of ascites is due to parenchymatous liver disease (80% of cases; mainly due to liver cirrhosis/damage to the liver and pronounced remodeling of the liver tissue). In about 20% of cases, advanced tumor disease (so-called “malignant ascites”) is present.
Causes of ascites:
- Portal-hypertensive ascites – liver cirrhosis and other causes of portal hypertension (portal hypertension; portal hypertension).
- Cardiac-related ascites – right heart failure, severe heart failure (cardiac insufficiency).
- Pancreatogenic conditioned ascites – acute pancreatitis (inflammation of the pancreas) and pancreatic fistulas.
- Biliary (“gallbladderbedinger”) conditioned ascites – leakage after biliary surgery, gallbladder rupture or perforation.
- Inflammatory ascites – bacterial; tuberculous.
- Malignant ascites – peritoneal carcinomatosis (infestation of the peritoneum (peritoneum) with multiple malignant tumor cells), tumor types see below differential diagnoses (about 10% of all ascites patients).
- Other (rare) causes – chylous (“clouded by emulsified fats milky”; leakage of lymphatic fluid in drainage disorder in the ductus thoracicus) or nephrogenic (“kidney-related”).
A distinction is made between exudate and transudate, where exudate is usually inflammation-related secretions (bloody, purulent; turbid) and transudate is non-inflammation-related secretions (slightly yellowish; clear) (see below laboratory diagnostics).
The following forms of ascites can be distinguished:
- Inflammatory ascites – ascites caused by inflammation.
- Non-inflammatory ascites – this includes ascites caused by tumor diseases (so-called malignant ascites)
- Hemorrhagic ascites – ascites containing blood cells.
- Chylous ascites – accumulation of lymphatic fluid in the abdominal cavity.
Ascites can be a symptom of many diseases (see under “Differential diagnoses”).
Course and prognosis:The course and prognosis depend on the cause and severity of ascites.Patients with malignant ascites in pancreatic cancer (pancreatic cancer), gastric cancer and colon cancer (stomach cancer) survive one to four months after diagnosis.Ascites in ovarian cancer (ovarian cancer) is evaluated differently. In 70% of cases, malignant ascites occurs at the time of initial diagnosis.50% of patients with liver cirrhosis (liver shrinkage) die within two years after the initial development of ascites. Note: Any new-onset ascites requires diagnostic puncture to determine the genesis (cause).
