Ascites Flashcards
1
Q
What is ascites?
A
Accumulation of fluid in the abdominal cavity
2
Q
What is the pathology of ascites?
A
- ↑ Na and water
- 75% due to portal hypertension
- Underfilling: Removal of fluid in the splanchnic vascular bed due to portal hypertention → ↓ blood volume → activating RAAS and Na and H20 retention
- Overflow: Inappropriate activation of RAAS
- Peripheral arterial vasodilation: portal hypertension = vasodilation = ↓ arterial blood volume. Na is retailed and plasma volume expands
3
Q
What are the risk factors/aetiology of ascites?
A
- Cirrhosis
- Malignancy
- Infection – esp. TB
- ↓ albumin
- Congestive cardiac failure
- Pericarditis
- Pancreatitis
- Myxoedema
4
Q
What are the signs and symptoms of ascites?
A
- Shifting dullness on abdominal examination
- Fluid thrills – for large ascites
- Abdominal distension
- Pain in abdomen
- Nausea
- Appetite suppression
- Dyspnoea – due to pressure
- Hernia – pushed out due to pressure
- Signs of liver disease if cause
5
Q
What diseases present similarly to ascites?
A
• Other causes of abdominal mass
6
Q
What investigations are conducted when ascites are investigated?
A
• Measurement of abdominal girth/weight • FBC • Renal function tests • LFTs - increased albumin • Clotting screen • TFTs Aspiration microscopy Amylase - rule out pancreatitis • Abdominal ultrasound
7
Q
What are the surgical treatments for ascites?
A
- Paracentesis – needle inserted into the peritoneal cavity to obtain ascites fluid
- Transjugular intrahepatic portosystemic shunt (TIPS)
8
Q
What are the pharmacological treatments for ascites?
A
- Diuretics – spironolactone is 1st line
* Palliative care
9
Q
What are the non pharmacological treatments for ascites?
A
• Restricted salt intake
