ABSTRACT
The differential diagnosis of ascites often leads to confusion and an inability to
exclude its multitude of causes in many patients. In this review, we outline the clinical
features and laboratory investigations that usually elucidate the cause of ascites
for the clinician in a simple and logical manner. Roughly 80-85% of cases of ascites
are related to underlying chronic liver disease, but cardiac failure, tuberculosis,
malignancy-related ascites and other less common causes should always be considered.
Careful evaluation of the patient, including a clinical history, physical examination
and diagnostic paracentesis should routinely be performed to determine the cause of
ascites. Fluid should be sent for cell count and albumin along with simultaneous determination
of serum albumin to determine the serum: ascites albumin gradient. This gradient allows
classification of the cause of ascites into portal hypertension-related and nonrelated
with a diagnostic accuracy of ≥97%. The causes of ascites are individually discussed
in relationship to their clinical features and to the laboratory investigations that
are relevant in each situation.
KEY WORDS
ascites - differential diagnosis - ascites causes - serum ascites albumin gradient
