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Flashcards in Ascites Deck (12)
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1

what is it

fluid within the peritoneal cavity, causing abdominal swelling

cirrhosis is the commonest cause

2

precipitating factors

high sodium diet
hepatocellular carcinoma
splanchnic vein thrombosis

3

pathology

in cirrhosis, peripheral arterial vasodilatation (mediated by NO) --> reduction in effective blood volume, activation of sympathetic NS + renin-angiotensin system --> renal salt and water retention

4

what encourages the formation of oedema?

hypoalbuminaemia

5

non-portal hypertension causes

malignancy
cardiac failure
nephrotic syndrome

6

clinical features

fullness in flanks
shifting dullness

tense ascites: uncomfortable + produces resp distress

7

what do you need to look at in a diagnostic aspiration of fluid?

albumin: transudate/exudate
neutrophil count: ?underlying SBP
Gram stain and culture
Cytology: malignant?
Amylase: to exclude pancreatic ascites

8

Treatment aim

to reduce sodium intake + increase renal excretion of sodium --> net reabsorption of fluid from the ascites into the circulating volume

9

Pharmacological treatment

Diuretic: spironolactone (aldosterone antagonist)

salt & fluid restriction

albumin/colloid replacement

10

what is paracentesis

perforation of a cavity of the body/ a cyst with a hollow needle to remove fluid or gas

to relieve symptomatic tense ascites

11

what to do for resistant ascites

transjugular intrahepatic portosystemic shunt (TIPS)

12

what anasarca

generalised oedema including skin + subcut tissue

its associated with nephrotic syndrome