Ascites differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Diseases that cause ascites should differentiate from each others, such as cirrhosis, Alcoholic hepatitis, Budd-Chiari syndrome, Constrictive pericarditis, Heart failure, Myxedema, Cancer, Nephrotic syndrome, Pancreatitis, Serositis, and Tuberculosis. The ascites may be transudate (serum-ascites albumin gradient [SAAG] ≥ 1.1 g/dL) or exudate (serum-ascites albumin gradient [SAAG] < 1.1 g/dL).

Differentiating Other Diseases Caused Ascites

Type Diseases History and Symptoms Physical Examination Laboratory Findings Other Findings
GI symptoms Extra-GI symptoms Liver function test Biochemical test
Jaundice Abdominal pain Hematemesis Nausea Weight loss Dyspnea Cough Chest pain Fever Spider angioma Abdominal tenderness Jugular venous distention Pitting edema Muffled heart sounds ALT AST Bili Amylase /Lipase Cr ESR Na-K
Transudate

(SAAG≥ 1.1g/dL)

Cirrhosis ++ + + + + - - - - + + - - - ↑↑ ↑↑ ↑↑ Normal Normal Normal Normal
Alcoholic hepatitis - - - + + - - - + - - - - - ↑↑↑ Normal Normal Normal Normal Normal
Budd-Chiari syndrome - + - + + - - - + - - - - - Normal Normal Normal Normal
Constrictive pericarditis - - - - - + - + + - - ++ - + Normal Normal Normal Normal Normal Normal
Heart failure - - - - + + + + - - - + + - Normal Normal Normal Normal Normal Normal
Myxedema - - - - - + - - - - - - ++ - Normal Normal Normal Normal Normal Normal
Portal hypertension +/- + + + + - - - - + - - - - Normal Normal Normal
Exudate

(SAAG< 1.1g/dL)

Cancer + + - + ++ - - - - - - - - - Normal Normal Normal Normal Normal ↑↑ Normal -
Nephrotic syndrome - - - + - - - - - - - - ++ - Normal Normal Normal Normal ↑↑ ↑↑
Pancreatitis +/- +++ - ++ - - - + + - ++ - - - Normal Normal Normal ↑↑ Normal Normal
Serositis - + - + + - - +/- + - + - - - Normal Normal Normal Normal Normal Normal -
Tuberculosis - + - + + ++ ++ ++ +/- - + - - - Normal Normal Normal Normal Normal ↑↑ Normal

References




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