Supplementation of potassium and chloride may be necessary during diuretic therapy to avoid an imbalance of these electrolytes. Medical treatment includes restriction of fluid and sodium intake and administration of diuretics. The problems of fluid and electrolyte imbalance that are associated with ascites, and the potential for mechanical trauma due to pressure against internal organs adjacent to the abdominal cavity necessitate some kind of symptomatic relief. Because ascites is symptomatic of an underlying disorder that can range from liver failure to endocrine disease, treatment of the primary disorder is a major goal. Because the fluid has a high colloidal osmotic pressure owing to its high protein content, it is not readily reabsorbed from the peritoneal cavity.
Some of the fluid enters the thoracic duct, but if the pressure is high enough, the excess fluid will ooze from the surface of the liver into the peritoneal cavity. As the pressure increases there is movement of protein-rich plasma filtrate into the hepatic lymphatics. In portal hypertension there is increased pressure within the sinusoids and hepatic veins. It may be associated with any of numerous disorders, including neoplastic and inflammatory disorders of the peritoneum that produce increased permeability of the peritoneal capillaries severe hypoalbuminemia from any cause portal hypertension associated with cirrhosis of the liver, advanced congestive heart failure, and constrictive pericarditis and hyperaldosteronism with increased retention of sodium and water. Abnormal accumulation of serous fluid ( edema) within the peritoneal cavity.
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