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Liver and intrahepatic bile ducts-nontumor

General concepts

Ascites


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 28 April 2012, last major update April 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Excess fluid in peritoneal cavity; usually detectable when 500 ml; usually serous, < 3 g/dl of protein
● Presence of neutrophils suggests secondary infection, red blood cells suggests disseminated intraabdominal cancer, hydrothorax suggests long standing process with seepage through transdiaphragmatic lymphatics
Causes: sinusoidal hypertension drives fluid into space of Disse, normally removed by hepatic lymphatics
● Ascites is promoted by hypoalbuminemia, cirrhosis, portal hypertension

Clinical images
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Severe ascites due to cirrhosis

Treatment
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● Treat underlying disorder; diuretics and salt restriction; if necessary, peritoneal dialysis or hemodialysis (Nefrologia 2011;31:648)
● Liver transplantation for refractory ascites, which otherwise has poor prognosis (World J Gastroenterol 2009;15:67)

Cytology description
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● Ascites fluid cytology is almost always negative in patients with cirrhosis, even those known or suspected to have hepatocellular carcinoma (Cytojournal 2009 Aug 7;6:16)

Cytology images
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Ascites fluid cytology

               
Various images in patients with ascites, all interpreted as negative

Additional references
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Baillieres Clin Gastroenterol 1997;11:365, Best Pract Res Clin Endocrinol Metab 2003;17:607

End of Liver and intrahepatic bile ducts-nontumor > General concepts > Ascites


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