Ascites

Question 1

PE

Answer 1

full, tense, bulging abdomen

Question 2

Diagnosis

Answer 2

• abdominal ultrasound (see if there is fluid there)

- abdominal paracentesis (needle into peritoneal cavity and drain fluid)

Question 3

SAAG

Answer 3

> 1.1 then portal HTN from cirrhosis or ascites from cirrhosis

Question 4

Treatment

Answer 4

• Na+ restrict (2g/day)

- Aldosterone antagonists (Spironolactone 50-100 mg) with Lasix 40 mg (loop diuretic)

Question 5

If patient is not tolerating spironolactone with laxis

Answer 5

Add midodrine (raise BP so patient can tolerate)

Question 6

Cannot tolerate regimen with Midodrine added

Answer 6

• Large volume paracentesis (4-8 L over 2 weeks)
• Dec BP, Inc Scr, reduces mortality)
• To help give IV albumin

Question 7

Lastline treatment

Answer 7

• TIPS procedure
• sent and bypass liver
• used for refractory ascites and variceal bleeding
• 40% of patients develop HE