Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-10: Malignant Ascites + Key Features Download Section PDF Listen +++ ++ Two-thirds of cases are due to peritoneal carcinomatosis from adenocarcinomas of the Ovary Uterus Pancreas Stomach Colon Lung Breast One-third of cases are due to lymphatic obstruction or portal hypertension from Hepatocellular carcinoma Diffuse hepatic metastases + Clinical Findings Download Section PDF Listen +++ ++ Nonspecific abdominal discomfort and weight loss Increased abdominal girth Nausea or vomiting caused by partial or complete intestinal obstruction + Diagnosis Download Section PDF Listen +++ ++ Abdominal CT Useful to demonstrate primary malignancy or hepatic metastases Seldom confirms diagnosis of peritoneal carcinomatosis Paracentesis demonstrates Low serum ascites–albumin gradient (< 1.1 mg/dL) Increased total protein (> 2.5 g/dL) Elevated WBC (often both neutrophils and mononuclear cells but with a lymphocyte predominance) Ascitic fluid cytology is positive in 95% Laparoscopy is diagnostic in patients with negative cytology + Treatment Download Section PDF Listen +++ ++ Diuretics not useful in controlling ascites Periodic large-volume paracentesis for symptomatic relief; for patients approaching end of life, indwelling (PleurXTM) peritoneal catheters can be left in place for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites Intraperitoneal chemotherapy sometimes used Prognosis is extremely poor: only 10% survival at 6 months Ovarian cancer is an exception; with surgical debulking and intraperitoneal chemotherapy, long-term survival is possible