Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Abdo Medicine > Ascites > Flashcards

Ascites Flashcards

1
Q

How do you classify the causes of ascites

A

Serum-ascitic albumin gradient

Portal hypertensive (transudative ascites) - SAAG greater than 1.1 g/dL
Non-portal hypertensive (exudative ascites) - SAAG less than 1.1 g/dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some causes of portal hypertensive ascites

A

Cirrhosis and secondary portal hypertension
Congestive cardiac failure
Hepatic venous occlusion (eg. Budd-Chiari syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some causes of non-portal hypertensive ascites

A 
Malignant ascites
Pancreatic ascites
Nephrotic syndrome
Infection (eg. TB)
Hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some differentials of ascites

A 
Fat
Faeces
Flatus
Foetus
Fibroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the complications of ascites

A

Spontaneous bacterial peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is spontaneous bacterial peritonitis

A

Acute bacterial infection of ascitic fluid
Occurs in aproximately 15% cirrhotic ascites
Can precipitate acute-on-chronic liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How might spontaneous bacterial peritonitis present

A

30% asymptomatic

Abdo pain or tenderness
Fever
Altered mental status
Nausea/vomiting
Diarrhoea

Signs of sepsis may be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What might you see on an AXR of a patient with ascites

A

Detection of intraperitoneal fluid requires at least 500mL

Ground glass appearance
Loss of psoas shadows (due to fluid accumulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you manage ascites

A

Management varies depending on cause

ETOH avoidance
Daily weights- aim to reduce 0.5kg per day
Fluid restrict: less than 1.5L/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat cirrhotic ascites

A

Salt restriction
Diuretics- spironolactone ± frusemide
Paracentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is paracentesis

A

Removal of fluid from the abdomen caused by ascites

Can be diagnostic or therapeutic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you treat malignant ascites

A

Palliative treatment

May require total paracentesis for comfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you treat pancreatic ascites

A

Usually associated with a pseudocyst so requires surgical input

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a pancreatic pseudocyst

A

A collection of fluid rich in amylase and other pancreatic enzymes
Usually appear several weeks after the onset of pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What test is diagnostic of spontaneous bacterial peritonitis

A

Ascitic fluid absolute neutrophil count greater than 250 cells/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you treat spontaneous bacterial peritonitis

A

Broad spectrum antibiotics

IV if sepsis, encephalopathy or GI bleeding

17
Q

What are the indications for use of a shunt in the management of ascites

A

In diuretic-resistant ascites

18
Q

How may shunting be performed in an ascitic patient

A

Peritoneovenous shunting
Denver shunt
Transjugular intrahepatic portosystemic stent shunt (TIPS)

19
Q

What is peritoneovenous shunting

A

Subcutaneous silastic catheter used to drain the fluid into the jugular vein

Also called a LeVeen shunt

20
Q

What is the Denver shunt

A

A modification to the peritoneovenous shunt

Adding a small subcutaneous pump that can be compressed externally

21
Q

What is TIPS

A

Transjugular intrahepatic portosystemic stent shunt
Side-to-side shunt
Stenting a channel between a branch of the portal vein and the hepatic vein

22
Q

What are important negatives in a patient with ascites?

A

CLD
ALF/decompensation
Signs of cause: Raised JVP, periorbital oedema

23
Q

What does SAAG stand for?

A

Serum ascites albumin gradient

24
Q

How is SAAG calculated?

A

Serum albumin - ascites albumin

25
Q

How do you carry out a paracentesis?

A

Using a pig-tail drain or Bonnano catheter

26
Q

What are the indications for a therapeutic paracentesis?

A

Pain or discomfort
Respiratory compromise
Renal impairment

27
Q

What are the risks of paracentesis?

A

Severe hypovolaemia: Replenish albumin

SBP

Abdo Medicine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions