What is anasarca from cirrhosis called?

Anasarca from Cirrhosis: Terminology and Classification

Anasarca from cirrhosis is called Grade 3 (large) ascites, which is defined as ascites causing marked abdominal distension. 1

Classification of Ascites in Cirrhosis

Ascites in cirrhosis is classified into three grades according to severity:

• Grade 1 (mild): Ascites is only detectable by ultrasound examination
• Grade 2 (moderate): Ascites causing moderate symmetrical distension of the abdomen
• Grade 3 (large): Ascites causing marked abdominal distension 1, 2

When ascites becomes severe enough to cause generalized edema throughout the body (anasarca), it represents advanced decompensated cirrhosis with significant portal hypertension.

Other Terms Used to Describe Severe Ascites

When ascites is extensive and accompanied by anasarca, several other terms may be used clinically:

• Tense ascites: Refers to ascites under high pressure causing significant abdominal distension 2
• Massive ascites: Describes a very large volume of ascitic fluid 2
• Refractory ascites: Ascites that cannot be mobilized or recurs rapidly despite maximal medical therapy 1, 2

Pathophysiology of Severe Ascites in Cirrhosis

The development of severe ascites in cirrhosis involves:

1. Portal hypertension: Increased hydrostatic pressure within hepatic sinusoids favors fluid transudation into the peritoneal cavity 1
2. Sodium and water retention: Due to activation of the renin-angiotensin-aldosterone system 3
3. Peripheral arterial vasodilation: Leading to underfilling of circulatory volume 4

Clinical Significance and Prognosis

The presence of severe ascites (Grade 3) indicates advanced liver disease and carries significant prognostic implications:

• Patients with cirrhosis and ascites have a 1-year survival rate of 85% and a 5-year survival rate of 56% without liver transplantation 2, 3, 4
• Severe ascites increases the risk for other complications including:
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Hepatic hydrothorax 5, 6

Management Considerations

Management of severe ascites (Grade 3/anasarca) typically requires:

• Large volume paracentesis (LVP) with intravenous albumin replacement 2, 3
• Sodium restriction and diuretic therapy (spironolactone and furosemide) 2
• Consideration of transjugular intrahepatic portosystemic shunt (TIPS) in appropriate candidates 2, 3
• Evaluation for liver transplantation, which offers the most definitive treatment 2, 3

Diagnostic Approach

When evaluating severe ascites:

• Diagnostic paracentesis is essential with measurement of:
  • Serum-ascites albumin gradient (SAAG) - ≥1.1 g/dL indicates portal hypertension with 97% accuracy
  • Neutrophil count to rule out spontaneous bacterial peritonitis
  • Total protein, culture, and other tests as indicated 2
• Abdominal ultrasound to evaluate liver appearance and confirm ascites 2

Severe ascites with anasarca represents advanced decompensated cirrhosis and should prompt urgent evaluation for liver transplantation in suitable candidates.