Ascites

Question 1

Ascites

Answer 1

build up of fluid in the peritoneum in abdomen

Question 2

causes

Answer 2

cirrhosis
hepatitis
hepatocarcinoma

Question 3

signs

Answer 3

swelling
abdomen distension
bloating
history of liver disease
shifting dullness

Question 4

investigations

Answer 4

tap - investigate the fluid
USS
measure serum albumin to determine cause

Question 5

management

Answer 5

1st line:
low salt diet
NSAIDs only in cirrhosis

2nd line:
spironolactone
furosemide

• acsites drainage
• manage underlying cause
• prophylactic antibiotics

Question 6

serum ascites albumin concentration

Answer 6

high value: transudate
congestive pericarditis
HF
cirrhosis

low value: exudate
nephrotic syndrome
cancer of peritoneum
pancreatitis

Question 7

complications

Answer 7

Spontaneous bacterial peritonitis (E.coli)

fever, abdo pain, ascites

culture, bloods

IV cefotaxime
tap, empirical antibiotics and human albumin

Question 8

what is a contraindication for performing a tap

Answer 8

DIC signs

Question 9

when should prophylactic antibiotics should be given and what is given

Answer 9

previous episode of SBP
fluid protein <15

ciprofloxacin