Causes of ascites in children

Ascites in children refers to the abnormal accumulation of fluid within the peritoneal cavity, leading to abdominal distension.

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There are various potential causes of ascites in children, ranging from benign conditions to serious underlying diseases. Here’s an overview of common causes of ascites in children:

1. Liver Disease:

• Cirrhosis: Although rare in children, cirrhosis can lead to portal hypertension and subsequent ascites. Causes of pediatric cirrhosis include metabolic disorders, chronic hepatitis, autoimmune hepatitis, biliary atresia, and Wilson disease.
• Hepatitis: Viral hepatitis, autoimmune hepatitis, or toxic hepatitis can cause liver inflammation and fibrosis, leading to ascites.

1. Congestive Heart Failure (CHF):

• Cardiac Causes: Congenital heart defects, cardiomyopathy, or other cardiac conditions can result in CHF and subsequent ascites due to fluid overload.

1. Nephrotic Syndrome:

• Glomerular Disease: Nephrotic syndrome, characterized by proteinuria, hypoalbuminemia, and edema, can lead to ascites as a result of decreased oncotic pressure and sodium retention.

1. Peritoneal Disorders:

• Peritoneal Infections: Peritonitis, often secondary to appendicitis, perforated viscus, or intra-abdominal abscess, can cause ascites.
• Peritoneal Tuberculosis: Tuberculous peritonitis, although rare in children, can lead to ascites in regions where tuberculosis is endemic.

1. Malignancies:

• Hematologic Malignancies: Leukemia or lymphoma can cause ascites due to infiltration of the peritoneum or hepatic metastases.
• Solid Tumors: Neuroblastoma, Wilms tumor, hepatoblastoma, or other solid tumors can also lead to ascites through direct compression or metastatic spread.

1. Renal Disorders:

• Renal Failure: Acute or chronic renal failure can lead to fluid retention and ascites due to decreased renal excretion of sodium and water.
• Nephrogenic Ascites: Rarely, congenital or acquired renal disorders can lead to ascites, such as polycystic kidney disease or congenital nephrotic syndrome.

1. Malnutrition:

• Kwashiorkor: Severe protein-energy malnutrition, such as kwashiorkor, can lead to hypoalbuminemia and ascites due to decreased oncotic pressure.

1. Pancreatic Disorders:

• Pancreatitis: Acute or chronic pancreatitis can lead to ascites as a result of pancreatic enzyme leakage and inflammation.

1. Genetic Disorders:

• Trisomy 21 (Down Syndrome): Children with Down syndrome may develop ascites due to associated congenital heart defects, leukemia, or other medical conditions.

1. Autoimmune Disorders:
   • Systemic Lupus Erythematosus (SLE): SLE or other autoimmune diseases can lead to ascites as a result of systemic inflammation and immune-mediated processes.
2. Infections:
   • Tuberculosis: Besides peritoneal tuberculosis, other infectious causes such as bacterial peritonitis or parasitic infections (e.g., schistosomiasis) can lead to ascites.
3. Metabolic Disorders:
   • Wilson Disease: This inherited disorder of copper metabolism can lead to hepatic dysfunction and subsequent ascites.
4. Idiopathic Ascites:
   • Unidentified Cause: In some cases, ascites may occur without an identifiable underlying cause, termed idiopathic ascites.

Diagnosis of the underlying cause of ascites in children involves a comprehensive medical history, physical examination, laboratory tests (e.g., liver function tests, renal function tests, serum albumin), imaging studies (e.g., ultrasound, CT scan), and sometimes invasive procedures such as paracentesis for fluid analysis. Treatment depends on addressing the underlying cause, such as managing liver disease, heart failure, or infection, and may include diuretics, dietary modifications, or surgical interventions in some cases.