1.8.7 Ascites

Question 1

Your patient has ascites. How will you manage?

Answer 1

• ID and treat cause
  
  • Cancer, liver failure, acute, chronic?
  • Surg, trauma, burn –> large volume resuscitation?
  • Liver dz = continuous reacummulation
• Diuresis
  
  • Furosemide, aldactone
  • Low sodium diet
• Paracentesis
  
  • Empty bladder prior to procedure

Question 2

Your patient with liver dz develops SBP. What is it? When would you suspect?

Answer 2

• Infxn of ascites fluid common in decompensated cirrhosis
• Suspect: fever, abd pain, decreased LOC in pt with ascites
• Send para fluid for C&S

Question 3

How will you treat your patient’s SBP?

Answer 3

• General approach
  
  • Empiric coverage: gram neg and anaerobes
• Zosyn: gram neg and anaerobes
• Ertapenem: gram neg and anaerobes
• Ceftriaxone: gram neg only
• Flagyl