ABC of diseases of liver, pancreas, and biliary system: portal hypertension-2. Ascites, encephalopathy, and other conditions.

Ascites is caused by cirrhosis in 75% of cases, malignancy in 10%, and cardiac failure in 5%; other causes account for the remaining 10%. In most patients the history and examination will give valuable clues to the cause of the ascites—for example, signs of chronic liver disease, evidence of cardiac failure, or a pelvic mass. The formation of ascites in cirrhosis is due to a combination of abnormalities in both renal function and portal and splanchnic circulation. The main pathogenic factor is sodium retention. About half of patients with cirrhosis develop ascites during 10 years of observation. The development of ascites is an important event in chronic liver disease as half of cirrhotic patients with ascites die within two years.