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Cirrhotic ascites

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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This is a transudate ascites with a protein content that is rarely greater than 2g per litre. The main aetiological factor is portal hypertension

Features associated with cirrhotic ascites include:

  • ascites is associated with sodium retention (reduced urinary sodium excretion)
  • serum sodium is usually slightly low but there is an increase in total body sodium
  • sodium retention is due to:
    • secondary aldosteronism (with increased renin and aldosterone levels)
    • a 'third factor' is postulated and thought to act via the proximal tubule
  • may be a pleural effusion (usually right-sided) in up to two-thirds of cases
  • bacteriological investigation is important - gram- negative infection may occur spontaneously or complicate paracentesis. Many cirrhotic patients have associated alcoholism and are prone to develop tuberculosis - tuberculous peritonitis may occur.

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