Ascites

Question 1

What is ascites?

Answer 1

Abnormal accumulation of fluid in the peritoneal cavity

Question 2

What are the causes of ascites?

Answer 2

Determined using serum-ascites albumin gradient (SAAG)
SAAG = (albumin levels in serum) - (albumin levels in ascitic fluid)
High SAAG (≥ 1.1 g/dL, transudate): Portal hypertension
Low SAAG ascites (< 1.1 g/dL, exudate): Hypoalbuminemia, Malignancy, Pancreatitis, Infection (i.e. tuberculosis)

Question 3

What are the clinical features of ascites?

Answer 3

Progressive abdominal distension
Shifting dullness
Symptoms of abdominal distension (Early satiety, Weight gain, Dyspnea)
Signs of underlying disease (i.e. liver / heart failure, Virchow’s node from malignancy)

Question 4

How is ascites diagnosed?

Answer 4

(Clinical chemistry) Dilutional hyponatremia (intravascular volume depletion triggers RAAS leading to increased sodium retention), Hypoalbuminemia
(Imaging) US / Ultrasound-guided diagnostic paracentesis, CT

Question 5

What is the treatment for ascites?

Answer 5

(General) Treatment of the underlying disease, sodium restriction, avoid over-hydration
(Diuretic therapy) More responsive in transudative ascites
(e.g.Spironolactone)
(Refractory ascites) Therapeutic large-volume paracentesis or Transjugular intrahepatic portosystemic shunt (TIPS)

Question 6

What are the complications of ascites?

Answer 6

Spontaneous bacterial peritonitis