Exploring ascites: its significance, pathogenesis, aetiology, presentation, examinations and management strategies

Ascites is characterised by an accumulation of fluid in the peritoneal cavity. While it is commonly associated with liver cirrhosis, it may also result from malignancy, cardiac failure or renal disease. This clinical review explores the pathogenesis, clinical presentation, diagnostic approaches and management strategies for ascites, emphasising its multifaceted nature and clinical implications. The pathophysiology of cirrhotic ascites is largely attributed to splanchnic vasodilation and subsequent sodium and water retention, while non-cirrhotic causes are associated with various underlying mechanisms. Clinical presentations range from abdominal distension and discomfort to systemic signs of underlying diseases. Diagnosis involves imaging, ascitic fluid analysis and advanced laboratory tests to identify the aetiology and guide targeted interventions. Management requires a multidisciplinary approach, integrating sodium restriction, diuretic therapy, paracentesis, albumin infusion and, in some cases, transjugular intrahepatic portosystemic shunts (TIPS). Challenges such as refractory ascites and complications such as spontaneous bacterial peritonitis necessitate a thorough clinical assessment and management. Advanced clinical practitioners and gastroenterology teams play an essential role in optimising outcomes, ensuring patient safety and promoting quality of life.