What is the Difference Between Ascites and Peritonitis?

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Ascites and peritonitis are two distinct conditions related to the accumulation of fluid in the abdominal cavity. Here are the main differences between them:

Ascites:

  • Ascites is the accumulation of fluid in the peritoneal cavity, which is the space between the lining of the abdomen and the organs.
  • It is commonly caused by portal hypertension, which results from conditions such as cirrhosis, acute liver failure, alcoholic hepatitis, and hepatic vein thrombosis.
  • Ascites can also be caused by non-hepatic sources, such as heart failure and malignancy-related ascites.
  • One of the most serious complications of ascites is spontaneous bacterial peritonitis (SBP).

Peritonitis:

  • Peritonitis is the inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.
  • It is caused by a collection of blood, body fluids, or pus in the abdomen.
  • There are different types of peritonitis, including spontaneous bacterial peritonitis (SBP), which occurs in people with ascites.
  • SBP is defined as an ascitic fluid infection without an evident intra-abdominal surgically-treatable source.

In summary, ascites is the accumulation of fluid in the peritoneal cavity, while peritonitis is the inflammation of the peritoneum. SBP is a specific type of peritonitis that occurs in people with ascites and is caused by the infection of the ascitic fluid.

Comparative Table: Ascites vs Peritonitis

Ascites and peritonitis are both conditions related to the accumulation of fluid in the abdominal cavity, but they have distinct characteristics and causes. Here is a table comparing the differences between ascites and peritonitis:

Feature Ascites Peritonitis
Definition Ascites is the accumulation of lymphatic fluid within the peritoneal cavity. Peritonitis is an inflammation of the peritoneum, which can be caused by infection or other factors.
Causes Ascites is a major complication of decompensated liver disease and is often associated with cirrhosis. Peritonitis can be caused by various factors, including infection, trauma, or inflammation.
Types There are different types of peritonitis, such as spontaneous bacterial peritonitis (SBP) and secondary bacterial peritonitis. SBP is an acute ascites infection with an ascitic fluid polymorphonuclear (PMN) cell count of ≥250 cells/μL. There are separate categories for ascites, such as transudative and exudative ascites. Transudative ascites is caused by increased pressure in the blood vessels or decreased protein levels in the blood, while exudative ascites is caused by inflammation or infection.
Diagnosis Diagnosis of ascites is confirmed by checking for an elevated ascitic fluid lactate dehydrogenase, a decreased ascites glucose level, or a high ascitic fluid cell count. Diagnosis of peritonitis is based on physical examination, imaging studies, and laboratory tests, including ascitic fluid analysis.
Treatment Treatment for ascites involves reducing sodium intake and initiating diuretic therapy. In patients with refractory ascites, liver transplantation is the definitive treatment option. Treatment for peritonitis depends on the cause and may include antibiotics, surgery, or other interventions.

In summary, ascites is the accumulation of fluid in the peritoneal cavity, primarily caused by liver disease, while peritonitis is an inflammation of the peritoneum that can be caused by infection or other factors. The diagnosis and treatment of these conditions vary depending on the specific cause and type.