Suggested diagnostic approach to a patient with exudative ascites. Low ascitic fluid protein should direct practitioners to rule out nephrotic

syndrome as a cause for exudative ascites. *Consideration of lymphangioscintigraphy can be done at this point to rule out lymphatic obstruction

before invasive procedure. Note: CT = computed tomography.


Although nonhepatic causes account for only about 15% of all

patients with ascites, the differential diagnosis is quite broad and

includes neoplasms of the peritoneum, lymphatic obstruction,

nephrotic syndrome and pancreatitis.

 This differential

should also include mycobacterial infections, particularly in

immunosuppressed patients.


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