Himali Meshram
Ascites in Greek language means “bag”, “bladder” or “sack”.1 Ascites is defined as collection of fluid in the peritoneum.1,2 Ascitic fluid could be transudative or exudative. This is based upon the total protein concentration in the ascitic fluid; ratio of total protein in ascitic fluid and serum, or ratio of lactic dehydrogenase in ascitic fluid and serum.3

There are various etiologies of ascites and they differ in infants and children.1

Causes of fetal ascites1
Gastrointestinal diseases: Malrotation of intestines, intussception, atresia of the small or large intestines, volvulus, biliary atresia.
Genitourinary diseases: Hydronephrosis, polycystic kidney disease, urinary obstruction.
Cardiac diseases: Heart failure, arrhythmias
Metabolic disease: Niemann pick type C, lysosomal storage disease
Chylous ascites: Intestinal lymphangiectasia
Infections: syphilis, cytomegalovirus, toxoplasmosis
Hematologic: Hemolytic anemia, haemochromatosis
Chromosomal abnormalities: Turner’s syndrome; trisomy 13,18, 21

Causes of neonatal ascites1
Hepatobiliary diseases: biliary atresia, viral hepatitis, Budd Chiari syndrome, congenital hepatic fibrosis
Genitourinary disorders: posterior urethral valve, ureterocele, rupture of bladder, nephrotic syndrome
Gastrointestinal disorders: Intestinal atresia, malrotation, intestinal perforation
Cardiac diseases: Heart failures, arrhythmias
Hematologic diseases: Neonatal hematochromatosis
Metabolic diseases: Mucopolysaccharidosis VIII

Causes of ascites in infants and children1
Hepatobiliary disorders: cirrhosis due to any chronic liver disease, acute hepatitis, budd chiari syndrome, congenital hepatic fibrosis
Gastrointestinal diseases: Intestinal atresia, pancreatitis, appendicitis
Serositis: Eosinophilic enteritis, inflammatory bowel disease
Neoplasms: Wilm’s tumor, mesothelioma, lymphoma, germ cell malignancies, ovarian tumors
Cardiac diseases: Heart failure
Pseudo-ascites: Ovarian cyst, celiac disease, mesothelioma
Genitourinary disorders: Nephrotic syndrome.
Chylous ascites: Lymphatic duct trauma or obstruction, intestinal lymphangiectasia
Toxins: Ethanol, methotrexate, 6-mercaptopurine

Various theories have been proposed for the formation of ascites. These include the following:
1) Underfilling theory: Portal hypertension causes decreased sequestration of fluid in splanchnic circulation which causes hypotension and activates renin angiotensinogen aldosterone and sympathetic systems resulting in renal sodium and water retention.
2) Overflow theory: There is renal sodium and water retention in the absence of volume depletion.
3) Peripheral arterial vasodilation: Due to portal hypertension underfilling occurs leading to renal sodium and water retention. Overfilling theory operates later in the natural history of cirrhosis.3

Ascites Ascites 10/02/2019
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