may cause extravasation of fluids

Sodium retention

Peritoneal inflammation

In most cases, ascites appears as part of a well-recognized illness, such as:

Cirrhosis

Congestive heart failure

Nephrosis

Disseminated carcinomatosis

Note: Ascites in itself is not an illness but a complication of an established illness. The
physician should determine that the development of ascites is a consequence of the
basic underlying disease and not due to the presence of a separate or related disease
process (Harrison’s).

PATHOPHYSIOLOGY

Increased hydrostatic pressure

Cirrhosis

Hepatic vein occlusion (Budd-Chiari syndrome)

IVC obstruction

Constrictive pericarditis

Congestive heart failure

Decreased colloid osmotic pressure

in patients with

Partial obstruction of the common bile duct

Cirrhosis or primary sclerosing cholangitis (PSC), where scarring prevents intrahepatic

ducts from dilating

If you look at the imaging, there shouldn’t have space between the liver and the right
kidney

Most common: portal hypertension

Better than ultrasonography

Assessing head of pancreas

Indentifying choledocholithiasis in distal common bile duct

When ducts are not dilated

ERCP (Endoscopic Retrograde Cholangiopancreatography)

“Gold Standard” for identifying choledocholithiasis

Used to make diagnosis of primary sclerosing cholangitis

Pathognomonic findings are multiple strictures of bile ducts with dilatations proximal to
strictures

Approximately 75% of patients with PSC have IBD