Ascites is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Complications can include spontaneous bacterial peritonitis.In the developed world, the most common cause is liver cirrhosis. Other causes include cancer, heart failure, tuberculosis, pancreatitis, and blockage of the hepatic vein. In cirrhosis, the underlying mechanism involves high blood pressure in the portal system and dysfunction of blood vessels. Diagnosis is typically based on an examination together with ultrasound or a CT scan. Testing the fluid can help in determining the underlying cause.Treatment often involves a low-salt diet, medication such as diuretics, and draining the fluid. A transjugular intrahepatic portosystemic shunt (TIPS) may be placed but is associated with complications. Attempts to treat the underlying cause, such as by a liver transplant 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. The term is from the Greek askítes meaning "baglike". Signs and symptoms
Mild ascites is hard to notice, but severe ascites leads to abdominal distension.
In case of minor thrombosis, there are some chances of survival using cadaveric liver transplant. Causes
Causes of high serum-ascites albumin gradient (SAAG or transudate) are
Cirrhosis – 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%)
Heart failure – 3%
Hepatic venous occlusion: Budd–Chiari syndrome or veno-occlusive disease
Constrictive pericarditis
Kwashiorkor (childhood protein-energy malnutrition)Causes of low SAAG ("exudate") areCancer (metastasis and primary peritoneal carcinomatosis) – 10%
Infection: Tuberculosis – 2% or spontaneous bacterial peritonitis
Pancreatitis – 1%
Serositis
Nephrotic syndrome
Hereditary angioedemaOther rare causesMeigs syndrome
Vasculitis
Hypothyroidism
Renal dialysis
Peritoneum mesothelioma
Abdominal tuberculosis
Mastocytosis

Diagnosis
Routine complete blood count (CBC), basic metabolic profile, liver enzymes, and coagulation should be performed. Most experts recommend a diagnostic paracentesis be performed 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, albumin, and cell counts (red and white). Additional tests will be performed if indicated such as microbiological culture, Gram stain and cytopathology.The serum-ascites albumin gradient (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.Ultrasound investigation is often performed prior to 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 Budd-Chiari syndrome (thrombosis of the hepatic vein) and portal vein thrombosis.