ascites Flashcards
What is ascites
Accumulation of free fluid in the peritoneal cavity
what are the commonest causes of ascites
malignant disease: hepatic / peritoneal
cardiac failure
hepatic cirrhosis
other causes of ascites
Hypoproteinaemia: nephrotic syndrome, protein-losing enteropathy, malnutrition
Pancreatitis
Lymphatic obstruction
Infection: TB
Hepatic venous occlusion: Budd–Chiari syndrome, veno-occlusive disease
Rare: Meigs’ syndrome, hypothyroidism
When is ascites symptomatic
small volumes can be asymptomatics
symptoms usually occurs >1L such as abdominal distension, fullness in the flanks shifting dullness and fluid thrill
symptoms of ascites
everted umbilicus, divarication of the recti, scrotal oedema and dilated abdominal veins (with portal hypertension).
how to investigate ascites
USS is the best
paracentesis (drainage) can determine cause
distinguish transudate from exudate by SAAG = serum albumin – ascites albumin
what does cirrhosis cause in SAAG
typically a transudate (total protein
what does portal htn cause in SAAG
A SAAG > 11 g/L is 96% predictive that ascites is due to portal hypertension
what other condition cause transudate SAAG
Venous outflow obstruction due to cardiac failure or hepatic venous outflow obstruction can also cause transudative ascites (SAAG > 11 g/L) but, unlike in cirrhosis, total protein is usually > 25 g/L.
causes of Exudative ascites
(protein > 25 g/L or SAAG
what if there is amylase in ascites
shows pancreatic ascites
causes according to appearance of ascites fluid
Cirrhosis: clear, straw-coloured or light green
Malignant disease: bloody
Infection: cloudy
Biliary communication: heavy bile staining
Lymphatic obstruction: milky-white (chylous)
useful investiagations after paracentesis
Total albumin (plus serum albumin)
Amylase
WCC
Cytology
Microscopy and culture
How to manage ascites
sodium restriction - steroids and nsaids avoid (Na retention)
Diuretics
Paracentesis
Transjugular intrahepatic portosystemic stent shunt
