Pediatric Ascites Revisited

Ascites is the pathologic fluid accumulation within the peritoneal cavity. Ascitic fluid represents a state of total-body sodium and water excess. Its Etiology includesgastrointestinal, genitourinary, cardiac and metabolic disorders, infections, haematologic and chromosomal abnormalities. Causes neonatal ascites are different from infants and children group. Most cases of ascites are due to liver disease or due to some precipitating factors deteriorating liver functions. History of abdominal distension, increasing weight, respiratory embarrassment, and associated pedal edema associated with it. Ascites needs to be differentiated from abdominal distension due to other causes like gross obesity, gaseous distension, bowel obstruction, abdominal cysts or masses. Investigations should be directed to rule out the cause of ascites. Ascitic fluid drainage is a useful procedure to made a diagnosis and decide the line of treatment accordingly. Umbilical Hernia, Hydrothorax, Spontaneous Bacterial Peritonitis are some dreadful complications of Ascites and its underlying etiology. Its management includes non pharmacological and medical treatment. Various advanced medication and surgeries like TIPSS, Peritoneovenous Shunt, Portosystemic Shunting and Liver Transplantation will promise a better outcome. INTRODUCTION Ascites is of Greek derivation (askites/askhos) which refers to a “bag”, “bladder” or “sack”. The word describes pathologic fluid accumulation within the peritoneal cavity (Figure 1). Ascites can occur at any age and in utero. In children it is usually the result of liver or renal disease. Figure 1: Child with ascites Background The peritoneum produces a fluid that acts as a lubricant and allows the abdominal organs to glide smoothly over one another. An excess of this fluid which can build up between visceral and parietal layers is called ascites. Ascites can be associated with portal hypertension. The higher portal pressure can be caused by liver damage. It can also be caused by impaired drainage in the lymph system which takes excess fluid and particles away from the liver. Low levels of albumin and other proteins in the blood also contribute to ascites. The force that holds plasma water within the blood vessels is reduced. Plasma water is lost into the abdominal cavity. Albumin in the ascitic fluid pulls yet more fluid across into this cavity. Blood flow to the kidneys might be reduced. This leads to increased secretion of aldosterone. This causes the kidneys to retain salt and water. Urinary output is decreased, and fluid is International Journal of Gastroenterology, Hepatology, Transplant & Nutrition Director – Institute of Pediatric Gastroenterology & Hepatology; Director – Institute of Multi Organ Transplant; Chancellor, Nims University Rajasthan Jaipur – India 303121 Address for Correspondence Prof. (Dr.) Balvir S Tomar E-mail: [email protected] Access this article online QR Code Website: www.journal.pghtn.com