Ascites Etiology and Diagnosis

Causes of Ascites

The American Association for the Study of Liver Diseases recommends that cirrhosis, which accounts for 75-85% of ascites cases in Western countries, be considered the primary cause of ascites, followed by malignancies, heart failure, tuberculosis, and pancreatic diseases 1, 2.
The European Association for the Study of the Liver states that cirrhosis is responsible for approximately 75-85% of all ascites cases worldwide, with alcoholic cirrhosis being the most common cause among cirrhosis cases, followed by non-alcoholic steatohepatitis (NASH) 4, 5.
The American Heart Association notes that heart failure can be distinguished by elevated jugular venous distension and high levels of brain natriuretic peptide (median pro-BNP of 6100 pg/mL versus 166 pg/mL in cirrhosis) 6, 3.

The American College of Gastroenterology recommends that the initial evaluation of ascites include a thorough medical history to identify risk factors for chronic liver disease, cancer, heart failure, kidney disease, or tuberculosis, as well as a physical examination to assess for flank dullness and jugular venous distension 1, 6.
The European Association for the Study of the Liver suggests that abdominal ultrasonography is necessary in obese patients to confirm the presence of ascite 6, 3.
The American Association for the Study of Liver Diseases states that diagnostic paracentesis with appropriate analysis of ascitic fluid is the most rapid and cost-effective method for diagnosing the cause of ascites, and should include measurements of the serum-ascites albumin gradient (SAAG), cell count, culture, and total protein concentration 1, 6, 3.

The American Association for the Study of Liver Diseases notes that the development of ascites in cirrhosis reduces 5-year survival from 80% to 30% 2, 3.
The European Association for the Study of the Liver reports that approximately 20% of patients with ascites die within the first year after diagnosis 4, 5.
The American College of Gastroenterology recommends that patients who develop ascites be considered for liver transplantation evaluation, which offers the most definitive curative treatment 2, 3.