Evaluation of ascites

Last reviewed: 3 Apr 2025
Last updated: 18 Feb 2025

Summary

Differentials

Common

  • Hepatitis C
  • Alcohol-related liver disease
  • Congestive heart failure
  • Nephrotic syndrome
  • Pancreatitis
  • Metabolic dysfunction-associated steatotic liver disease
Full details

Uncommon

  • Hepatitis B
  • Primary biliary cholangitis
  • Autoimmune hepatitis
  • Hemochromatosis
  • Wilson disease
  • Constrictive pericarditis
  • Budd-Chiari syndrome
  • Chronic renal failure
  • Protein-losing enteropathy
  • Peritoneal carcinomatosis
  • Myxedema
  • Schistosomiasis
  • Systemic lupus erythematosus
  • Fulminant hepatic failure
  • Hepatic metastases
  • Tuberculous peritonitis
  • Chylous ascites
  • Urogenital surgical trauma
  • Bile ascites
  • Ovarian tumors
  • Tricuspid regurgitation
Full details

Contributors

Authors

Kenneth D. Rothstein, MD

Professor of Clinical Medicine

Perelman School of Medicine

University of Pennsylvania

Philadelphia

PA

Disclosures

KDR declares that he has no competing interests.

Brittney Shupp, DO

Gastroenterology Fellow

Department of Gastroenterology

St. Luke’s University Health Network

Bethlehem

PA

Disclosures

BS declares that she has no competing interests.

Vishal Patel, MD

Assistant Professor of Medicine

Associate Medical Director, Liver Transplant

Drexel University College of Medicine

Tower Health Transplant Institute

Center for Liver Disease

Reading

PA

Disclosures

VP declares that he has no competing interests.

Acknowledgements

Dr Kenneth D. Rothstein and Dr Vishal Patel would like to gratefully acknowledge Dr Srikrishna Nagri and Dr Sury Anand, previous contributors to this topic.

Disclosures

SN and SA declare that they have no competing interests.

Peer reviewers

Jeremiah S. Kurz, MD

Attending

New York Methodist Hospital

Brooklyn

NY

Disclosures

JSK declares that he has no competing interests.

References

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Key articles

Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.Full text  Abstract

Aithal GP, Palaniyappan N, China L, et al. Guidelines on the management of ascites in cirrhosis. Gut. 2021 Jan;70(1):9-29.Full text  Abstract

European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397-417Full text

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