Differential Diagnosis for Ascites
The differential diagnosis for ascites can be organized into the following categories:
- Single Most Likely Diagnosis
- Cirrhosis: This is the most common cause of ascites, particularly in patients with a history of liver disease or alcohol abuse. Cirrhosis leads to portal hypertension, which causes fluid to accumulate in the peritoneal cavity.
- Other Likely Diagnoses
- Peritoneal Carcinomatosis: Metastatic cancer to the peritoneum can cause ascites, especially in patients with a history of abdominal or pelvic malignancies.
- Nephrotic Syndrome: Severe proteinuria and hypoalbuminemia can lead to ascites due to decreased oncotic pressure.
- Congestive Heart Failure: Right-sided heart failure can cause ascites due to increased venous pressure and fluid overload.
- Tuberculous Peritonitis: This is a common cause of ascites in endemic areas, particularly in patients with a history of tuberculosis or immunocompromised states.
- Do Not Miss Diagnoses
- Spontaneous Bacterial Peritonitis (SBP): This is a life-threatening condition that requires prompt diagnosis and treatment. Patients with cirrhosis and ascites are at high risk of developing SBP.
- Ovarian Torsion: This is a surgical emergency that can cause ascites, particularly in patients with a history of ovarian cysts or masses.
- Intra-Abdominal Hemorrhage: Bleeding into the peritoneal cavity can cause ascites and is a medical emergency.
- Rare Diagnoses
- Pancreatic Ascites: This is a rare condition caused by a pancreatic fistula or leak, leading to ascites.
- Chylous Ascites: This is a rare condition caused by a lymphatic leak or obstruction, leading to ascites with high triglyceride levels.
- Eosinophilic Ascites: This is a rare condition caused by eosinophilic gastroenteritis or other eosinophilic disorders, leading to ascites with high eosinophil counts.