771:
579:
40:
571:
625:(SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites. A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive as a cause.
778:
Ascites is generally treated while an underlying cause is sought, in order to relieve symptoms and to prevent complications and progression. In people with mild ascites, therapy is usually as an outpatient. The goal is weight loss of no more than 1.0 kg/day for people with both ascites and
863:
and no more than 0.5 kg/day for people with ascites alone. If daily weights cannot be obtained, diuretics can also be guided by the urinary sodium concentration. Dosage is increased until a negative sodium balance occurs. A random urine sodium-to-potassium ratio of > 1 is 90%
676:
Refractory ascites is less common, difficult to treat, and exists in two subtypes: i) diuretic intractable ascites makes up the majority of refractory ascites cases, where diuretic treatment is difficult due to diuretic-induced complications such as elevated creatinine and
883:
may be needed to achieve adequate control of fluid retention and congestion. The use of such mechanical methods of fluid removal can produce meaningful clinical benefits in people with diuretic resistance and may restore responsiveness to conventional doses of diuretics.
945:
concluded that "TIPS was more effective at removing ascites paracentesis without a significant difference in mortality, gastrointestinal bleeding, infection, and acute renal failure. However, TIPS patients develop hepatic encephalopathy significantly more often."
871:
Diuretic resistance: Diuretic resistance can be predicted by giving 80 mg intravenous furosemide after 3 days without diuretics and on an 80 mEq sodium/day diet. The urinary sodium excretion over 8 hours < 50 mEq/8 hours predicts resistance.
631:
investigation is often done before attempts to remove fluid from the abdomen. This may reveal the size and shape of the abdominal organs, and
Doppler studies may show the direction of flow in the portal vein, as well as detecting
949:
Another option for people with refractory or malignant ascites is the automated low-flow ascites pump (Alfapump), an implanted machine, which uses a pump to move ascites from the peritoneal cavity to the bladder for urination.
1380:
Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG (August 1992). "The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites".
2365:
2350:
2038:"ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines"
836:. Diuretics for ascites should be taken once a day. Generally, the starting dose is oral spironolactone 100 mg/day (max 400 mg/day). 40% of people will respond to spironolactone. For nonresponders, a
724:. Transudates have low protein (<30 g/L), low LDH, high pH, normal glucose, and fewer than 1 white cell per 1000 mm. Clinically, the most useful measure is the difference between ascitic and
656:, and is treatable with diet control and diuretic treatment. Refractory ascites is characterized as ascites that recurs or does not recede post-paracentesis, despite diet control and diuretic treatment.
2479:
390:, may be considered. Of those with cirrhosis, more than half develop ascites in the ten years following diagnosis. Of those in this group who develop ascites, half will die within three years.
958:
Exudative ascites generally does not respond to manipulation of the salt balance or diuretic therapy. Repeated paracentesis and treatment of the underlying cause is the mainstay of treatment.
1769:
Salerno F, Badalamenti S, Incerti P, et al. (1987). "Repeated paracentesis and i.v. albumin infusion to treat 'tense' ascites in cirrhotic patients. A safe alternative therapy".
804:(production of urine) since the person now has more fluid than salt concentration. Salt restriction is effective in about 15% of these people. Water restriction is needed if
2472:
1809:"A pathophysiological interpretation of unresponsiveness to spironolactone in a stepped-care approach to the diuretic treatment of ascites in nonazotemic cirrhotic patients"
859:
Monitoring diuresis: Diuresis can be monitored by weighing the person daily. The goal is weight loss of no more than 1.0 kg/day for people with both ascites and
3271:
2465:
1090:
783:
and no more than 0.5 kg/day for people with ascites alone. In those with severe ascites causing a tense abdomen, hospitalization is generally necessary for
1894:
Fogel MR, Sawhney VK, Neal EA, Miller RG, Knauer CM, Gregory PB (1981). "Diuresis in the ascitic patient: a randomized controlled trial of three regimens".
602:
if the ascites is new or if the person with ascites is being admitted to the hospital. The fluid is then reviewed for its gross appearance, protein level,
3123:
1973:
Runyon BA, Heck M (1996). "Utility of 24-hour urine sodium collection and urine Na/K ratios in the management of patients with cirrhosis and ascites".
640:. The sonographer also can estimate the amount of ascitic fluid, and difficult-to-drain ascites may be drained under ultrasound guidance. An abdominal
437:" (difference in percussion note in the flanks that shifts when the person is turned on the side), or in massive ascites, with a "fluid thrill" or "
312:, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and
731:
Portal hypertension plays an important role in the production of ascites by raising capillary hydrostatic pressure within the splanchnic bed.
934:
383:
441:" (tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen).
406:(askites ), meant "bag-like dropsy," from askĂłs (áŒÏÎșÏÏ), a leather bag or sheepskin (âwineskinâ) used for carrying wine, water or oil.
832:) is the drug of choice, because it blocks the aldosterone receptor in the collecting tubule. This choice has been confirmed in a
3116:
1641:
Castell, Donald O. (September 1967). "Ascites in cirrhosis: Relative importance of portal hypertension and hypoalbuminemia".
1620:
925:
In a minority of people with advanced cirrhosis that have recurrent ascites, shunts may be used. Typical shunts used are the
1896:
1727:"Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study"
1039:
770:
704:(>8 mmHg, usually around 20 mmHg (e.g., due to cirrhosis), while exudates are actively secreted fluid due to
750:
production is increased due to decreased perfusion of the kidney. Extreme disruption of the renal blood flow can lead to
3109:
2457:
2318:
2249:
1687:
Shear L, Ching S, Gabuzda GJ (1970). "Compartmentalization of ascites and edema in patients with hepatic cirrhosis".
1315:
919:
906:
levels in the blood, albumin is generally administered intravenously in proportion to the amount of ascites removed.
755:
537:
317:
145:
98:
2080:
937:(TIPS). However, none of these has been shown to extend life expectancy, and they are considered to be bridges to
1938:
820:
is one of the hormones that increase salt retention, a medication that counteracts aldosterone should be sought.
386:(TIPS) may be placed but is associated with complications. Attempts to treat the underlying cause, such as by a
2700:
622:
477:
1503:"The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club"
526:
1600:
1277:
833:
418:. People with ascites generally will complain of progressive abdominal heaviness and pressure as well as
1327:
Kumar & Clark's
Clinical Medicine e.8 Chapter 7: Liver, biliary tract and pancreatic disease Pg. 335
448:(perhaps due to cirrhosis or fibrosis of the liver) people may also complain of leg swelling, bruising,
2085:
743:
735:
2120:
Cosby RL, Yee B, Schrier RW (1989). "New classification with prognostic value in cirrhotic patients".
464:(peritoneal carcinomatosis) may complain of chronic fatigue or weight loss. Those with ascites due to
3085:
641:
506:
2994:
2380:
633:
497:
348:
183:
1214:
3040:
2620:
2561:
1994:"Furosemide-induced natriuresis as a test to identify cirrhotic patients with refractory ascites"
628:
607:
140:
856:
level and renal function should be monitored closely while the patient is on these medications.
2504:
2492:
2198:"EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis"
637:
501:
2420:
1337:
Branco-Ferreira M, Pedro E, Barbosa MA, Carlos AG (1998). "Ascites in hereditary angioedema".
2972:
2778:
2725:
2635:
2042:
975:
938:
930:
915:
709:
294:
433:
of the abdomen by visible bulging of the flanks in the reclining person ("flank bulging"), "
3070:
3060:
2999:
2952:
2935:
2854:
2695:
2566:
971:
751:
659:
Uncomplicated ascites is more common, responsive to treatment, and exists in three grades:
606:, and cell counts (red and white). Additional tests will be performed if indicated such as
587:
430:
415:
149:
8:
2704:
2630:
2605:
2369:
1014:
865:
701:
603:
445:
423:
419:
352:
313:
133:
2720:
2487:
728:
concentrations. A difference of less than 1 g/dl (10 g/L) implies an exudate.
3141:
3055:
2947:
2902:
2836:
2831:
2763:
2754:
2600:
2488:
2291:
2264:
2227:
2173:
2148:
1838:
1666:
1612:
1576:
1478:
1453:
1406:
1362:
1350:
1254:
1229:
1161:
1136:
734:
Regardless of the cause, sequestration of fluid within the abdomen leads to additional
553:
468:
may also complain of shortness of breath as well as wheezing and exercise intolerance.
127:
2374:
2056:
2037:
1859:
GinÚs P, Cårdenas A, Arroyo V, Rodés J (2004). "Management of cirrhosis and ascites".
1782:
3090:
3080:
3075:
3025:
2957:
2874:
2648:
2391:
2314:
2296:
2231:
2219:
2178:
2129:
2102:
2061:
2015:
1955:
1913:
1909:
1876:
1830:
1786:
1748:
1743:
1726:
1704:
1658:
1616:
1581:
1563:
1524:
1483:
1465:
1398:
1354:
1311:
1259:
1166:
759:
644:
is more accurate than a sonogram to reveal abdominal organ structure and morphology.
434:
309:
190:
115:
1842:
1670:
1410:
1366:
444:
Other signs of ascites may be present due to its underlying cause. For instance, in
3045:
2967:
2788:
2715:
2625:
2431:
2286:
2276:
2209:
2168:
2164:
2160:
2098:
2094:
2051:
2005:
1947:
1905:
1868:
1820:
1778:
1738:
1696:
1650:
1608:
1571:
1555:
1514:
1473:
1390:
1346:
1249:
1241:
1156:
1148:
926:
860:
780:
721:
387:
255:
120:
68:
33:
Peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum, abdominal dropsy
902:
may be needed in addition to medical treatments listed above. As this may deplete
3187:
3050:
2879:
2768:
2675:
2653:
2643:
2615:
2610:
2588:
2534:
2385:
2033:
1185:
876:
670:
438:
328:
324:
163:
1951:
1700:
1394:
652:
Uncomplicated ascites is characterized by receding or nonrecurring ascites post-
3182:
3030:
3020:
2962:
2897:
2811:
2214:
2197:
2196:
Angeli, Paolo; Bernardi, Mauro; Villanueva, CĂ ndid; et al. (August 2018).
1047:
821:
457:
403:
285:
229:
2434:
914:
Ascites that is refractory to medical therapy is considered an indication for
844:
is added at a dose of 40 mg/day (max 160 mg/day), or alternatively (
3265:
3133:
3035:
2816:
2710:
2690:
2396:
1567:
1543:
1469:
1427:
1193:
1152:
942:
903:
837:
790:
738:
by the kidneys due to stimulatory effect on blood pressure hormones, notably
725:
615:
591:
490:
465:
371:
356:
336:
213:
195:
171:
3101:
2359:
2010:
1993:
1599:
Kwo, Paul Y.; Strahotin, Cristina Simona (2011-01-01), Saxena, Romil (ed.),
1559:
1519:
1502:
801:
3243:
3164:
2912:
2907:
2773:
2680:
2539:
2300:
2223:
2182:
2106:
2065:
2019:
1880:
1825:
1808:
1585:
1528:
1487:
1263:
1170:
966:
It has been suggested that ascites was seen as a punishment especially for
899:
893:
880:
805:
784:
758:(SBP), due to decreased antibacterial factors in the ascitic fluid such as
705:
653:
599:
578:
542:
533:
449:
379:
344:
340:
217:
179:
175:
153:
2313:
Oettinger, Norbert. Die MilitÀrischen Eide der
Hethiter. Wiesbaden, 1976.
2245:
2133:
1959:
1917:
1834:
1790:
1752:
1708:
1662:
1402:
1358:
875:
If the person exhibits a resistance or poor response to diuretic therapy,
3233:
3154:
3149:
3065:
2942:
2573:
2415:
2149:"TIPS versus paracentesis for cirrhotic patients with refractory ascites"
1872:
987:
825:
817:
739:
681:; ii) diuretic resistant ascites does not respond to diuretic treatment.
678:
595:
511:
453:
3248:
3223:
3199:
3194:
3015:
2826:
2758:
2749:
2741:
2731:
2583:
2578:
2544:
2529:
2440:
1654:
849:
845:
841:
690:
611:
559:
360:
233:
224:
199:
2445:
2342:
2281:
1807:
Gatta A, Angeli P, Caregaro L, Menon F, Sacerdoti D, Merkel C (1991).
2556:
2549:
2524:
2426:
1245:
853:
829:
548:
484:
52:
1991:
868:
in predicting negative balance (> 78-mmol/day sodium excretion).
55:
that has resulted in massive ascites and prominent superficial veins
3177:
2930:
2859:
2783:
2519:
2246:"NICE Guidelines, UK 2018. (NICEGuidance IPG 631, replacing IPG479"
1454:"Refractory Ascites: Pathogenesis, Clinical Impact, and Management"
991:
852:). The ratio of 100:40 reduces risks of potassium imbalance. Serum
375:
304:, meaning "bag" or "sac") is the abnormal build-up of fluid in the
1500:
367:. Testing the fluid can help in determining the underlying cause.
132:
Increased abdominal size, increased weight, abdominal discomfort,
3218:
2869:
2593:
2496:
1336:
983:
717:
694:
364:
305:
203:
48:
39:
816:
Because salt restriction is the basic concept in treatment, and
2986:
2514:
2354:
2265:"Evaluation and management of patients with refractory ascites"
2195:
1379:
700:
Roughly, transudates are a result of increased pressure in the
574:
Ascites in a person with abdominal cancer as seen on ultrasound
522:
461:
359:. Diagnosis is typically based on an examination together with
332:
167:
86:
3172:
2821:
2670:
2083:(HFSA) 2006 Comprehensive Heart Failure Practice Guideline".
1992:
Spahr L, Villeneuve JP, Tran HK, Pomier-Layrargues G (2001).
747:
708:
or malignancy. As a result, exudates are high in protein and
399:
1452:
Siqueira, Fabiolla; Kelly, Traci; Saab, Sammy (2009-09-01).
1230:"Historical Aspects of Ascites and the Hepatorenal Syndrome"
666:
Grade 2: detectable with flank bulging and shifting dullness
570:
414:
Mild ascites is hard to notice, but severe ascites leads to
979:
967:
953:
273:
267:
258:
80:
71:
2078:
791:
High serum-ascites albumin gradient (transudative) ascites
1768:
487:â 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%)
2079:
Adams KF, Lindenfeld J, Arnold JM, et al. (2006). "
1858:
1806:
800:
Salt restriction is the initial treatment, which allows
1501:
Moore, K. P.; Wong, F.; Gines, P.; et al. (2003).
713:
598:
should be performed. Most experts recommend diagnostic
1893:
1544:"Guidelines on the management of ascites in cirrhosis"
1134:
1228:
Wong, Florence; Blendis, Laurence (29 October 2021).
308:. Technically, it is more than 25 ml of fluid in the
276:
264:
99:
89:
77:
2332:
2146:
270:
83:
1936:Runyon BA (1994). "Care of patients with ascites".
1725:Ginés P, Arroyo V, Quintero E, et al. (1987).
1724:
806:
serum sodium levels drop below 130 mmol L
299:
261:
74:
1605:Practical Hepatic Pathology: A Diagnostic Approach
922:is used to prioritize people for transplantation.
898:In those with severe (tense) ascites, therapeutic
351:. In cirrhosis, the underlying mechanism involves
1686:
1451:
1135:Pedersen, JS; Bendtsen, F; MĂžller, S (May 2015).
3272:Symptoms and signs: Digestive system and abdomen
3263:
663:Grade 1: mild, only visible on ultrasound and CT
2262:
2119:
2032:
1854:
1852:
2147:Saab S, Nieto JM, Lewis SK, Runyon BA (2006).
1931:
1929:
1927:
1802:
1800:
1764:
1762:
1720:
1718:
1682:
1680:
1607:, Saint Louis: W.B. Saunders, pp. 63â72,
669:Grade 3: directly visible, confirmed with the
3131:
3117:
2473:
935:transjugular intrahepatic portosystemic shunt
384:transjugular intrahepatic portosystemic shunt
2140:
2072:
2026:
1985:
1849:
1598:
1183:
2113:
2036:, Abraham WT, Chin MH, et al. (2005).
1924:
1887:
1797:
1759:
1715:
1677:
1541:
1330:
1227:
1040:"Ascites | Definition of Ascites by Lexico"
824:(or other distal-tubule diuretics, such as
697:. Amounts of up to 35 liters are possible.
3124:
3110:
2480:
2466:
1972:
1966:
1643:The American Journal of Digestive Diseases
1542:Moore, K. P.; Aithal, G. P. (2006-10-01).
1422:
1420:
1085:
38:
2290:
2280:
2213:
2172:
2055:
2009:
1935:
1824:
1742:
1575:
1518:
1477:
1310:. Oxford: Oxford University Press, 2003.
1253:
1160:
1130:
1128:
1126:
1124:
1122:
1120:
1118:
1116:
1114:
1112:
1091:"Ascites - Hepatic and Biliary Disorders"
1083:
1081:
1079:
1077:
1075:
1073:
1071:
1069:
1067:
1065:
754:. Other complications of ascites include
16:Abnormal build-up of fluid in the abdomen
2263:Senousy, B. E.; Draganov, P. V. (2009).
1009:
1007:
769:
577:
569:
353:high blood pressure in the portal system
2153:Cochrane Database of Systematic Reviews
1640:
1417:
1306:Warrell DA, Cox TN, Firth JD, Benz ED.
1177:
1141:Therapeutic Advances in Chronic Disease
514:(childhood protein-energy malnutrition)
3264:
1109:
1062:
990:4.16.7). A similar curse dates to the
961:
3105:
2461:
1302:
1300:
1298:
1004:
774:Diagram showing ascites being drained
636:(thrombosis of the hepatic vein) and
422:due to mechanical impingement on the
409:
1897:Journal of Clinical Gastroenterology
1601:"Clinical Features of Liver Disease"
1432:The Lecturio Medical Concept Library
518:Causes of low SAAG ("exudate") are
13:
2122:Mineral and Electrolyte Metabolism
1613:10.1016/b978-0-443-06803-4.00006-x
1351:10.1111/j.1398-9995.1998.tb04098.x
1295:
1095:Merck Manuals Professional Edition
689:Ascitic fluid can accumulate as a
684:
14:
3283:
2328:
2269:World Journal of Gastroenterology
2057:10.1161/CIRCULATIONAHA.105.167586
1137:"Management of cirrhotic ascites"
840:may also be added and generally,
756:spontaneous bacterial peritonitis
647:
538:spontaneous bacterial peritonitis
527:primary peritoneal carcinomatosis
318:spontaneous bacterial peritonitis
146:Spontaneous bacterial peritonitis
2252:from the original on 2021-10-29.
2081:Heart Failure Society of America
1910:10.1097/00004836-198100031-00016
590:(CBC), basic metabolic profile,
254:
243:>50% of people with cirrhosis
67:
2307:
2256:
2238:
2189:
1939:New England Journal of Medicine
1861:New England Journal of Medicine
1634:
1592:
1535:
1494:
1458:Gastroenterology and Hepatology
1445:
1373:
1321:
887:
2165:10.1002/14651858.CD004889.pub2
2099:10.1016/j.cardfail.2005.11.005
1270:
1221:
1207:
1032:
974:. This proposal builds on the
954:Low SAAG ("exudative") ascites
623:serum-ascites albumin gradient
478:serum-ascites albumin gradient
1:
1783:10.1016/S0168-8278(87)80067-3
1044:Lexico Dictionaries | English
997:
1744:10.1016/0016-5085(87)91007-9
1019:National Library of Medicine
918:. In the United States, the
811:
765:
582:Liver cirrhosis with ascites
565:
460:. Those with ascites due to
393:
349:blockage of the hepatic vein
316:. Complications can include
184:blockage of the hepatic vein
7:
2701:Charcot's cholangitis triad
1952:10.1056/NEJM199402033300508
1701:10.1056/NEJM197006182822502
1395:10.7326/0003-4819-117-3-215
1308:Oxford textbook of medicine
994:dynasty (12th century BC).
834:randomized controlled trial
456:, or mental changes due to
370:Treatment often involves a
327:, the most common cause is
300:
10:
3288:
3215:Cause of fluid collection
2215:10.1016/j.jhep.2018.03.024
2086:Journal of Cardiac Failure
909:
891:
744:sympathetic nervous system
496:Hepatic venous occlusion:
480:(SAAG or transudate) are:
3208:
3163:
3140:
3086:Sister Mary Joseph nodule
3008:
2985:
2923:
2890:
2847:
2804:
2797:
2740:
2662:
2503:
2406:
2336:
507:Constrictive pericarditis
471:
429:Ascites is detected with
402:ascites, originally from
289:
239:
223:
209:
189:
159:
139:
126:
114:
59:
46:
37:
29:
24:
1153:10.1177/2040622315580069
2011:10.1053/jhep.2001.20646
1560:10.1136/gut.2006.099580
1520:10.1053/jhep.2003.50315
795:
746:is also activated, and
608:microbiological culture
331:. Other causes include
2493:human digestive system
1826:10.1002/hep.1840140205
1282:Johns Hopkins Medicine
1234:Clinical Liver Disease
775:
638:portal vein thrombosis
583:
575:
502:veno-occlusive disease
2779:Obstructed defecation
2202:Journal of Hepatology
1554:(suppl 6): vi1âvi12.
1215:"Ascites: background"
1184:Staff writer (2010).
976:Hittite military oath
939:liver transplantation
931:peritoneovenous shunt
916:liver transplantation
773:
710:lactate dehydrogenase
581:
573:
374:, medication such as
3041:Aure-Rozanova's sign
3000:Hannington-Kiff sign
2995:HowshipâRomberg sign
2953:Aortic insufficiency
2855:Abdominal distension
2248:. 14 November 2018.
1873:10.1056/NEJMra035021
972:Proto-Indo-Europeans
970:-breakers among the
752:hepatorenal syndrome
634:BuddâChiari syndrome
588:complete blood count
498:BuddâChiari syndrome
431:physical examination
416:abdominal distension
150:hepatorenal syndrome
2606:Chilaiditi syndrome
1050:on October 25, 2019
978:as well as various
962:Society and culture
702:hepatic portal vein
446:portal hypertension
420:shortness of breath
355:and dysfunction of
314:shortness of breath
134:shortness of breath
3142:Volume contraction
2973:Grey Turner's sign
2903:Hepatosplenomegaly
2832:Abdominal guarding
2764:Fecal occult blood
2755:Fecal incontinence
2726:Mirizzi's syndrome
2636:Sherren's triangle
2489:Signs and symptoms
2407:External resources
1904:(Suppl 1): 73â80.
1655:10.1007/BF02236449
1240:(Suppl 1): 14â27.
776:
716:(<7.30), a low
584:
576:
554:Nephrotic syndrome
410:Signs and symptoms
380:draining the fluid
218:draining the fluid
3259:
3258:
3099:
3098:
3071:Fothergill's sign
3061:Rosenstein's sign
2981:
2980:
2936:Mallet-Guy's sign
2875:Shifting dullness
2696:Courvoisier's law
2455:
2454:
2282:10.3748/wjg.15.67
1622:978-0-443-06803-4
722:white blood cells
435:shifting dullness
310:peritoneal cavity
298:
247:
246:
191:Diagnostic method
51:of a person with
19:Medical condition
3279:
3126:
3119:
3112:
3103:
3102:
2802:
2801:
2789:Rectal discharge
2705:Reynolds' pentad
2644:Radiologic signs
2631:McBurney's point
2505:Gastrointestinal
2491:relating to the
2482:
2475:
2468:
2459:
2458:
2334:
2333:
2322:
2311:
2305:
2304:
2294:
2284:
2260:
2254:
2253:
2242:
2236:
2235:
2217:
2193:
2187:
2186:
2176:
2144:
2138:
2137:
2117:
2111:
2110:
2076:
2070:
2069:
2059:
2030:
2024:
2023:
2013:
1989:
1983:
1982:
1970:
1964:
1963:
1933:
1922:
1921:
1891:
1885:
1884:
1856:
1847:
1846:
1828:
1804:
1795:
1794:
1766:
1757:
1756:
1746:
1731:Gastroenterology
1722:
1713:
1712:
1684:
1675:
1674:
1638:
1632:
1631:
1630:
1629:
1596:
1590:
1589:
1579:
1539:
1533:
1532:
1522:
1498:
1492:
1491:
1481:
1449:
1443:
1442:
1440:
1438:
1424:
1415:
1414:
1383:Ann. Intern. Med
1377:
1371:
1370:
1334:
1328:
1325:
1319:
1304:
1293:
1292:
1290:
1288:
1274:
1268:
1267:
1257:
1246:10.1002/cld.1090
1225:
1219:
1218:
1211:
1205:
1204:
1202:
1200:
1181:
1175:
1174:
1164:
1132:
1107:
1106:
1104:
1102:
1087:
1060:
1059:
1057:
1055:
1046:. Archived from
1036:
1030:
1029:
1027:
1025:
1011:
927:portacaval shunt
861:peripheral edema
781:peripheral edema
720:level, and more
525:(metastasis and
388:liver transplant
303:
293:
291:
283:
282:
279:
278:
275:
272:
269:
266:
263:
260:
154:low blood sodium
121:Gastroenterology
103:
96:
95:
92:
91:
88:
85:
82:
79:
76:
73:
42:
22:
21:
3287:
3286:
3282:
3281:
3280:
3278:
3277:
3276:
3262:
3261:
3260:
3255:
3204:
3188:pulmonary edema
3159:
3136:
3130:
3100:
3095:
3056:Lockwood's sign
3004:
2977:
2948:Ballance's sign
2919:
2886:
2880:Fluid wave test
2843:
2837:Blumberg's sign
2793:
2769:Rectal tenesmus
2736:
2676:Councilman body
2658:
2601:Goodsall's rule
2589:Hypersalivation
2506:
2499:
2486:
2456:
2451:
2450:
2402:
2401:
2345:
2331:
2326:
2325:
2312:
2308:
2261:
2257:
2244:
2243:
2239:
2194:
2190:
2159:(4): CD004889.
2145:
2141:
2118:
2114:
2077:
2073:
2050:(12): 154â235.
2031:
2027:
1990:
1986:
1971:
1967:
1934:
1925:
1892:
1888:
1867:(16): 1646â54.
1857:
1850:
1805:
1798:
1767:
1760:
1723:
1716:
1689:N. Engl. J. Med
1685:
1678:
1639:
1635:
1627:
1625:
1623:
1597:
1593:
1540:
1536:
1499:
1495:
1450:
1446:
1436:
1434:
1426:
1425:
1418:
1378:
1374:
1335:
1331:
1326:
1322:
1305:
1296:
1286:
1284:
1276:
1275:
1271:
1226:
1222:
1213:
1212:
1208:
1198:
1196:
1192:. Oakland, CA:
1182:
1178:
1133:
1110:
1100:
1098:
1089:
1088:
1063:
1053:
1051:
1038:
1037:
1033:
1023:
1021:
1013:
1012:
1005:
1000:
964:
956:
912:
896:
890:
877:ultrafiltration
814:
798:
793:
768:
736:fluid retention
712:and have a low
687:
685:Pathophysiology
671:fluid wave test
650:
568:
476:Causes of high
474:
412:
396:
329:liver cirrhosis
325:developed world
257:
253:
216:, medications,
164:Liver cirrhosis
110:
101:
70:
66:
20:
17:
12:
11:
5:
3285:
3275:
3274:
3257:
3256:
3254:
3253:
3252:
3251:
3246:
3241:
3236:
3228:
3227:
3226:
3221:
3212:
3210:
3206:
3205:
3203:
3202:
3197:
3192:
3191:
3190:
3185:
3183:cerebral edema
3175:
3169:
3167:
3161:
3160:
3158:
3157:
3152:
3146:
3144:
3138:
3137:
3129:
3128:
3121:
3114:
3106:
3097:
3096:
3094:
3093:
3091:Blumer's shelf
3088:
3083:
3081:Massouh's sign
3078:
3076:Carnett's sign
3073:
3068:
3063:
3058:
3053:
3048:
3043:
3038:
3033:
3031:Hamburger sign
3028:
3026:Rovsing's sign
3023:
3021:Obturator sign
3018:
3012:
3010:
3006:
3005:
3003:
3002:
2997:
2991:
2989:
2983:
2982:
2979:
2978:
2976:
2975:
2970:
2965:
2960:
2958:Castell's sign
2955:
2950:
2945:
2940:
2939:
2938:
2927:
2925:
2921:
2920:
2918:
2917:
2916:
2915:
2910:
2900:
2898:Abdominal mass
2894:
2892:
2888:
2887:
2885:
2884:
2883:
2882:
2877:
2872:
2867:
2862:
2851:
2849:
2845:
2844:
2842:
2841:
2840:
2839:
2834:
2829:
2824:
2819:
2812:Abdominal pain
2808:
2806:
2799:
2795:
2794:
2792:
2791:
2786:
2781:
2776:
2771:
2766:
2761:
2752:
2746:
2744:
2738:
2737:
2735:
2734:
2729:
2723:
2718:
2707:
2698:
2693:
2684:
2683:
2678:
2666:
2664:
2660:
2659:
2657:
2656:
2651:
2649:Hampton's line
2639:
2638:
2633:
2628:
2623:
2618:
2613:
2608:
2603:
2597:
2596:
2591:
2586:
2581:
2576:
2571:
2570:
2569:
2564:
2554:
2553:
2552:
2547:
2542:
2532:
2527:
2522:
2517:
2511:
2509:
2501:
2500:
2485:
2484:
2477:
2470:
2462:
2453:
2452:
2449:
2448:
2437:
2423:
2411:
2410:
2408:
2404:
2403:
2400:
2399:
2388:
2377:
2362:
2346:
2341:
2340:
2338:
2337:Classification
2330:
2329:External links
2327:
2324:
2323:
2306:
2255:
2237:
2208:(2): 406â460.
2188:
2139:
2112:
2093:(1): e1âe122.
2071:
2025:
1984:
1965:
1923:
1886:
1848:
1796:
1758:
1714:
1695:(25): 1391â6.
1676:
1649:(9): 916â922.
1633:
1621:
1591:
1534:
1493:
1464:(9): 647â656.
1444:
1416:
1372:
1329:
1320:
1294:
1269:
1220:
1206:
1190:Dictionary.com
1176:
1108:
1061:
1031:
1002:
1001:
999:
996:
963:
960:
955:
952:
911:
908:
892:Main article:
889:
886:
822:Spironolactone
813:
810:
797:
794:
792:
789:
767:
764:
686:
683:
674:
673:
667:
664:
649:
648:Classification
646:
567:
564:
563:
562:
556:
551:
546:
540:
530:
516:
515:
509:
504:
494:
488:
473:
470:
458:encephalopathy
411:
408:
395:
392:
245:
244:
241:
237:
236:
230:Spironolactone
227:
221:
220:
211:
207:
206:
193:
187:
186:
161:
157:
156:
143:
137:
136:
130:
124:
123:
118:
112:
111:
109:
108:
63:
61:
57:
56:
44:
43:
35:
34:
31:
27:
26:
18:
15:
9:
6:
4:
3:
2:
3284:
3273:
3270:
3269:
3267:
3250:
3247:
3245:
3242:
3240:
3237:
3235:
3232:
3231:
3229:
3225:
3222:
3220:
3217:
3216:
3214:
3213:
3211:
3207:
3201:
3198:
3196:
3193:
3189:
3186:
3184:
3181:
3180:
3179:
3176:
3174:
3171:
3170:
3168:
3166:
3162:
3156:
3153:
3151:
3148:
3147:
3145:
3143:
3139:
3135:
3132:Disorders of
3127:
3122:
3120:
3115:
3113:
3108:
3107:
3104:
3092:
3089:
3087:
3084:
3082:
3079:
3077:
3074:
3072:
3069:
3067:
3064:
3062:
3059:
3057:
3054:
3052:
3049:
3047:
3046:Dunphy's sign
3044:
3042:
3039:
3037:
3036:Heel tap sign
3034:
3032:
3029:
3027:
3024:
3022:
3019:
3017:
3014:
3013:
3011:
3007:
3001:
2998:
2996:
2993:
2992:
2990:
2988:
2984:
2974:
2971:
2969:
2968:Cullen's sign
2966:
2964:
2961:
2959:
2956:
2954:
2951:
2949:
2946:
2944:
2941:
2937:
2934:
2933:
2932:
2929:
2928:
2926:
2922:
2914:
2911:
2909:
2906:
2905:
2904:
2901:
2899:
2896:
2895:
2893:
2889:
2881:
2878:
2876:
2873:
2871:
2868:
2866:
2863:
2861:
2858:
2857:
2856:
2853:
2852:
2850:
2846:
2838:
2835:
2833:
2830:
2828:
2825:
2823:
2820:
2818:
2817:Acute abdomen
2815:
2814:
2813:
2810:
2809:
2807:
2803:
2800:
2796:
2790:
2787:
2785:
2782:
2780:
2777:
2775:
2772:
2770:
2767:
2765:
2762:
2760:
2756:
2753:
2751:
2748:
2747:
2745:
2743:
2739:
2733:
2730:
2727:
2724:
2722:
2721:LĂ©pine's sign
2719:
2717:
2716:Murphy's sign
2713:
2712:
2711:cholecystitis
2708:
2706:
2702:
2699:
2697:
2694:
2692:
2689:
2686:
2685:
2682:
2679:
2677:
2674:
2672:
2668:
2667:
2665:
2661:
2655:
2652:
2650:
2647:
2645:
2641:
2640:
2637:
2634:
2632:
2629:
2627:
2626:Markle's sign
2624:
2622:
2621:Arapov's sign
2619:
2617:
2614:
2612:
2609:
2607:
2604:
2602:
2599:
2598:
2595:
2592:
2590:
2587:
2585:
2582:
2580:
2577:
2575:
2572:
2568:
2565:
2563:
2562:oropharyngeal
2560:
2559:
2558:
2555:
2551:
2548:
2546:
2543:
2541:
2538:
2537:
2536:
2533:
2531:
2528:
2526:
2523:
2521:
2518:
2516:
2513:
2512:
2510:
2508:
2502:
2498:
2494:
2490:
2483:
2478:
2476:
2471:
2469:
2464:
2463:
2460:
2447:
2443:
2442:
2438:
2436:
2433:
2429:
2428:
2424:
2422:
2418:
2417:
2413:
2412:
2409:
2405:
2398:
2394:
2393:
2389:
2387:
2383:
2382:
2378:
2376:
2372:
2371:
2367:
2363:
2361:
2357:
2356:
2352:
2348:
2347:
2344:
2339:
2335:
2320:
2319:3-447-01711-2
2316:
2310:
2302:
2298:
2293:
2288:
2283:
2278:
2274:
2270:
2266:
2259:
2251:
2247:
2241:
2233:
2229:
2225:
2221:
2216:
2211:
2207:
2203:
2199:
2192:
2184:
2180:
2175:
2170:
2166:
2162:
2158:
2154:
2150:
2143:
2135:
2131:
2127:
2123:
2116:
2108:
2104:
2100:
2096:
2092:
2088:
2087:
2082:
2075:
2067:
2063:
2058:
2053:
2049:
2045:
2044:
2039:
2035:
2029:
2021:
2017:
2012:
2007:
2003:
1999:
1995:
1988:
1980:
1976:
1969:
1961:
1957:
1953:
1949:
1946:(5): 337â42.
1945:
1941:
1940:
1932:
1930:
1928:
1919:
1915:
1911:
1907:
1903:
1899:
1898:
1890:
1882:
1878:
1874:
1870:
1866:
1862:
1855:
1853:
1844:
1840:
1836:
1832:
1827:
1822:
1818:
1814:
1810:
1803:
1801:
1792:
1788:
1784:
1780:
1776:
1772:
1765:
1763:
1754:
1750:
1745:
1740:
1737:(2): 234â41.
1736:
1732:
1728:
1721:
1719:
1710:
1706:
1702:
1698:
1694:
1690:
1683:
1681:
1672:
1668:
1664:
1660:
1656:
1652:
1648:
1644:
1637:
1624:
1618:
1614:
1610:
1606:
1602:
1595:
1587:
1583:
1578:
1573:
1569:
1565:
1561:
1557:
1553:
1549:
1545:
1538:
1530:
1526:
1521:
1516:
1513:(1): 258â66.
1512:
1508:
1504:
1497:
1489:
1485:
1480:
1475:
1471:
1467:
1463:
1459:
1455:
1448:
1433:
1429:
1423:
1421:
1412:
1408:
1404:
1400:
1396:
1392:
1389:(3): 215â20.
1388:
1384:
1376:
1368:
1364:
1360:
1356:
1352:
1348:
1344:
1340:
1333:
1324:
1317:
1316:0-19-262922-0
1313:
1309:
1303:
1301:
1299:
1283:
1279:
1273:
1265:
1261:
1256:
1251:
1247:
1243:
1239:
1235:
1231:
1224:
1217:. 2024-01-22.
1216:
1210:
1195:
1191:
1187:
1180:
1172:
1168:
1163:
1158:
1154:
1150:
1147:(3): 124â37.
1146:
1142:
1138:
1131:
1129:
1127:
1125:
1123:
1121:
1119:
1117:
1115:
1113:
1096:
1092:
1086:
1084:
1082:
1080:
1078:
1076:
1074:
1072:
1070:
1068:
1066:
1049:
1045:
1041:
1035:
1020:
1016:
1010:
1008:
1003:
995:
993:
989:
985:
981:
977:
973:
969:
959:
951:
947:
944:
943:meta-analysis
940:
936:
932:
928:
923:
921:
917:
907:
905:
904:serum albumin
901:
895:
885:
882:
878:
873:
869:
867:
862:
857:
855:
851:
847:
843:
839:
838:loop diuretic
835:
831:
827:
823:
819:
809:
807:
803:
788:
786:
782:
772:
763:
761:
757:
753:
749:
745:
741:
737:
732:
729:
727:
726:serum albumin
723:
719:
715:
711:
707:
703:
698:
696:
692:
682:
680:
672:
668:
665:
662:
661:
660:
657:
655:
645:
643:
639:
635:
630:
626:
624:
619:
617:
616:cytopathology
613:
609:
605:
601:
597:
593:
592:liver enzymes
589:
580:
572:
561:
557:
555:
552:
550:
547:
544:
541:
539:
535:
531:
528:
524:
521:
520:
519:
513:
510:
508:
505:
503:
499:
495:
492:
491:Heart failure
489:
486:
483:
482:
481:
479:
469:
467:
466:heart failure
463:
459:
455:
451:
447:
442:
440:
436:
432:
427:
425:
421:
417:
407:
405:
401:
391:
389:
385:
381:
377:
373:
372:low-salt diet
368:
366:
362:
358:
357:blood vessels
354:
350:
346:
342:
338:
337:heart failure
334:
330:
326:
321:
319:
315:
311:
307:
302:
296:
287:
281:
251:
242:
238:
235:
231:
228:
226:
222:
219:
215:
214:Low-salt diet
212:
208:
205:
201:
197:
196:Physical exam
194:
192:
188:
185:
181:
177:
173:
172:heart failure
169:
165:
162:
158:
155:
151:
147:
144:
142:
141:Complications
138:
135:
131:
129:
125:
122:
119:
117:
113:
106:
105:
94:
65:
64:
62:
60:Pronunciation
58:
54:
50:
45:
41:
36:
32:
28:
23:
3244:hydrosalpinx
3238:
3165:Hypervolemia
3134:volume state
3051:Alder's sign
2913:Splenomegaly
2908:Hepatomegaly
2864:
2774:Constipation
2709:
2687:
2681:Mallory body
2669:
2654:Klemm's sign
2642:
2616:Aaron's sign
2611:Dance's sign
2540:Trichophagia
2439:
2425:
2414:
2390:
2379:
2364:
2349:
2309:
2275:(1): 67â80.
2272:
2268:
2258:
2240:
2205:
2201:
2191:
2156:
2152:
2142:
2128:(5): 261â6.
2125:
2121:
2115:
2090:
2084:
2074:
2047:
2041:
2028:
2004:(1): 28â31.
2001:
1997:
1987:
1978:
1974:
1968:
1943:
1937:
1901:
1895:
1889:
1864:
1860:
1819:(2): 231â6.
1816:
1812:
1777:(1): 102â8.
1774:
1770:
1734:
1730:
1692:
1688:
1646:
1642:
1636:
1626:, retrieved
1604:
1594:
1551:
1547:
1537:
1510:
1506:
1496:
1461:
1457:
1447:
1435:. Retrieved
1431:
1386:
1382:
1375:
1345:(5): 543â5.
1342:
1338:
1332:
1323:
1307:
1285:. Retrieved
1281:
1272:
1237:
1233:
1223:
1209:
1199:December 14,
1197:. Retrieved
1189:
1179:
1144:
1140:
1099:. Retrieved
1094:
1052:. Retrieved
1048:the original
1043:
1034:
1022:. Retrieved
1018:
965:
957:
948:
924:
913:
900:paracentesis
897:
894:Paracentesis
888:Paracentesis
881:aquapheresis
874:
870:
858:
815:
799:
785:paracentesis
777:
733:
730:
706:inflammation
699:
688:
675:
658:
654:paracentesis
651:
627:
620:
600:paracentesis
585:
543:Pancreatitis
534:Tuberculosis
517:
475:
450:gynecomastia
443:
428:
413:
397:
369:
345:pancreatitis
341:tuberculosis
322:
249:
248:
180:pancreatitis
176:tuberculosis
3234:hydrothorax
3155:Hypovolemia
3150:Dehydration
3066:Cupola sign
2963:Kehr's sign
2943:Puddle sign
2574:Odynophagia
2416:MedlinePlus
2043:Circulation
1101:14 December
1024:14 December
866:sensitivity
826:triamterene
818:aldosterone
740:aldosterone
679:hypokalemia
596:coagulation
558:Hereditary
532:Infection:
512:Kwashiorkor
454:hematemesis
30:Other names
3249:hyperaemia
3224:transudate
3200:Lymphedema
3195:Angioedema
3016:Psoas sign
2848:Distension
2827:Baby colic
2759:encopresis
2750:Flatulence
2742:Defecation
2732:Nardi test
2691:Boas' sign
2584:Xerostomia
2579:Bad breath
2567:esophageal
2545:Pagophagia
2530:Aerophagia
2441:Patient UK
2392:DiseasesDB
1998:Hepatology
1975:Hepatology
1813:Hepatology
1771:J. Hepatol
1628:2023-11-18
1507:Hepatology
1097:. May 2016
1054:26 October
998:References
933:, and the
920:MELD score
850:torasemide
846:bumetanide
842:furosemide
760:complement
691:transudate
629:Ultrasound
612:Gram stain
560:angioedema
439:fluid wave
361:ultrasound
234:furosemide
225:Medication
200:ultrasound
2663:Accessory
2557:Dysphagia
2550:Geophagia
2525:Heartburn
2427:eMedicine
2232:206137363
1568:0017-5749
1470:1554-7914
1428:"Ascites"
1278:"Ascites"
1186:"Ascites"
1015:"Ascites"
941:. A 2006
854:potassium
830:amiloride
812:Diuretics
766:Treatment
566:Diagnosis
549:Serositis
485:Cirrhosis
424:diaphragm
394:Etymology
376:diuretics
295:romanized
240:Frequency
210:Treatment
116:Specialty
53:cirrhosis
3266:Category
3230:By site
3178:Anasarca
2931:Jaundice
2860:Bloating
2784:Diarrhea
2688:biliary:
2520:Vomiting
2432:ped/2927
2301:19115470
2250:Archived
2224:29653741
2183:17054221
2107:16500560
2066:16160202
2020:11124817
1881:15084697
1843:24614489
1671:28150018
1586:16966752
1529:12830009
1488:37967427
1411:24317271
1367:35762764
1264:34745581
1171:25954497
802:diuresis
586:Routine
536:â 2% or
128:Symptoms
3239:ascites
3219:exudate
2870:Tympany
2865:Ascites
2798:Abdomen
2594:Burping
2497:abdomen
2446:Ascites
2435:med/173
2386:D001201
2292:2653293
2174:8855742
2134:2682175
2034:Hunt SA
1981:: 571A.
1960:8277955
1918:7035545
1835:1860680
1791:3655306
1753:3297907
1709:4910836
1663:6039572
1577:1860002
1479:2886420
1403:1616215
1359:9636820
1339:Allergy
1255:8555459
1162:4416972
992:Kassite
982:hymns (
910:Surgery
718:glucose
695:exudate
642:CT scan
604:albumin
529:) â 10%
365:CT scan
323:In the
306:abdomen
297::
250:Ascites
204:CT scan
49:abdomen
25:Ascites
2987:Hernia
2891:Masses
2515:Nausea
2421:000286
2317:
2299:
2289:
2230:
2222:
2181:
2171:
2132:
2105:
2064:
2018:
1958:
1916:
1879:
1841:
1833:
1789:
1751:
1707:
1669:
1661:
1619:
1584:
1574:
1566:
1527:
1486:
1476:
1468:
1437:1 July
1409:
1401:
1365:
1357:
1314:
1287:1 July
1262:
1252:
1169:
1159:
986:7.89,
929:, the
742:. The
693:or an
614:, and
594:, and
523:Cancer
472:Causes
462:cancer
378:, and
347:, and
333:cancer
168:cancer
160:Causes
107:
3209:Other
3173:Edema
3009:Other
2924:Other
2822:Colic
2671:liver
2507:tract
2375:789.5
2228:S2CID
1839:S2CID
1667:S2CID
1407:S2CID
1363:S2CID
980:Vedic
748:renin
404:Greek
400:Latin
363:or a
301:askos
290:áŒÏÎșÏÏ
286:Greek
104:-teez
2805:Pain
2757:and
2535:Pica
2381:MeSH
2370:9-CM
2315:ISBN
2297:PMID
2220:PMID
2179:PMID
2157:2010
2130:PMID
2103:PMID
2062:PMID
2016:PMID
1956:PMID
1914:PMID
1877:PMID
1831:PMID
1787:PMID
1749:PMID
1705:PMID
1659:PMID
1617:ISBN
1582:PMID
1564:ISSN
1525:PMID
1484:PMID
1466:ISSN
1439:2021
1399:PMID
1355:PMID
1312:ISBN
1289:2021
1260:PMID
1201:2017
1167:PMID
1103:2017
1056:2019
1026:2017
968:oath
828:and
796:Diet
621:The
545:â 1%
493:â 3%
398:The
382:. A
47:The
2495:or
2397:943
2366:ICD
2360:R18
2351:ICD
2287:PMC
2277:doi
2210:doi
2169:PMC
2161:doi
2095:doi
2052:doi
2048:112
2006:doi
1948:doi
1944:330
1906:doi
1869:doi
1865:350
1821:doi
1779:doi
1739:doi
1697:doi
1693:282
1651:doi
1609:doi
1572:PMC
1556:doi
1548:Gut
1515:doi
1474:PMC
1391:doi
1387:117
1347:doi
1250:PMC
1242:doi
1194:IAC
1157:PMC
1149:doi
988:AVS
879:or
848:or
500:or
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