Ascites is diagnosed by detecting shifting dullness on abdominal percussion, although ultrasound or CT can detect much smaller amounts of fluid. In advanced cases, the belly is taut, the umbilicus is flat or everted, and a fluid wave can be elicited. Clinical examination usually differentiates ascites from obesity, gaseous distention, pregnancy, or ovarian tumors and other intra-abdominal masses, but imaging or diagnostic paracentesis may occasionally be required. In most disorders, the fluid is clear and straw-colored. Clinical diagnosis may be difficult, as the fluid masks signs of peritonitis.
Survival depends on early, vigorous antibiotic therapy.
Treatment Bed rest and dietary Na restriction are the mainstays of therapy. Diuretics should be used if rigid Na restriction fails. Inadequate dietary Na restriction is the usual reason for persistent ascites. Therapeutic paracentesis is an alternative approach. Even single total paracentesis appears safe.