Ascites Flashcards
classified into
- high serum-ascites albumin gradient
- low SAAG (low SAAG is normal)
what is the cause of a high vs low SAAG
high = due to portal HTN - increased hydrostatic pressure causes fluid to leak into peritoneal space (ascites). the SAAG .,. increases bc the serum albumin is more concentrated. albumin cannot move across as it is a big molecule.
low (normal) = not due to portal HTN
which is transudate vs exudate SAAG
high = transudate low = exudate
causes of ascites with low SAAG
(=all causes not due to portal HTN) constrictive pericarditis cancer nephrotic syndrome pancreatitis
causes of ascites with high SAAG
(= causes due to portal HTN)
cirrhosis
heart failure
hepatic venous occlusion
percussion in ascites
shifting dullness.
percuss middle of abdomen to elicit resonant note due to gas in abdomen
gradually percuss laterally until dullness heard (fluid)
keep hand in same position and ask patient to roll onto side
wait 30 seconds
percuss where it was dull - should now be resonant
only positive if 1-2l of fluid
treatment of ascites
low sodium diet
sprinolactone
fluid drainage
complications of ascites
hepatorenal syndrome
spontaneous bacterial peritonitis
thrombosis
what is hepatorenal syndrome
rapid decrease in renal function in patients with liver failure/cirrhosis
infecting organisms spontaneous bacterial peritonitis
eek!!!
e coli
enterococci
klebsiella
what does fluid aspiration show in SBP
neutrophils
treatment of SBP
3rd gen cephalosporin
who does SBP occur in
pts with cirrhosis
