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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Sometimes it is difficult for a health care practitioner to appreciate that ascites is present. Most commonly, however, the patient presents with the complaint of abdominal fullness and pressure, and the ascites can be found on physical examination. The diagnosis is aided by learning the past medical history of the patient so the physician make the decision to order additional tests.

A complete blood count (CBC) may be helpful in looking for potential infection (an elevated white blood cell count), anemia (a low hemoglobin), and indirectly, liver function (low platelet count). Other blood tests may be helpful in assessing electrolyte balance, kidney and liver function, and the amount of protein in the body.

If a patient presents with new-onset ascites, paracentesis is recommended to obtain samples of the fluid for analysis to assist in making the diagnosis. Removal of the fluid may assist with symptom control (see below). Paracentesis is a sterile procedure whereby a needle is placed through the abdominal wall into the peritoneal cavity and fluid is removed.

Gastroenterologists (specialists in the digestive system including the liver) use a formula measuring the amount of albumin (protein) in the blood compared to the amount found in the ascites fluid to help them classify the type of ascites and assist with the diagnosis. If the amount of protein is higher in the serum, it may be due to liver disease, heart failure, and Budd-Chiari syndrome. If the ratio is low, then cancer and pancreatitis are potential causes.

Laboratory tests on the ascites fluid may include evaluation for infection and the assessment of electrolytes and other substances.

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