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Ascities Flashcards

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1
Q
  1. Q: What is ascites?
A

A: Abnormal accumulation of fluid within the peritoneal cavity.

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2
Q
  1. Q: What is the most common cause of ascites?
A

A: Cirrhosis, accounting for approximately 85% of cases.

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3
Q
  1. Q: Name two causes of portal hypertension leading to ascites.
A

A: Cirrhosis and Budd-Chiari syndrome.

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4
Q
  1. Q: Name one malignancy commonly associated with ascites.
A

A: Peritoneal carcinomatosis.

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5
Q
  1. Q: How does hypoalbuminemia contribute to ascites?
A

A: By reducing intravascular colloid osmotic pressure.

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6
Q
  1. Q: What happens when hydrostatic pressure increases in portal veins?
A

A: Fluid transudation from the gastrointestinal tract and peritoneum occurs.

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7
Q

Q: What role does nitric oxide play in ascites?

A

A: It causes splanchnic arterial vasodilation and renal hypoperfusion.

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8
Q

Q: How does malignancy cause ascites?

A

A: Through lymphatic blockage and increased vascular permeability.

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9
Q

Q: Name two symptoms of ascites.

A

A: Progressive abdominal distension and early satiety.

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10
Q

Q: What is shifting dullness?

A

A: A change from dull to tympanic resonance when a patient changes position.

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11
Q

Q: What is the fluid wave test?

A

A: A wave transmitted across the abdomen when tapped, indicating ascitic fluid.

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12
Q

Q: What is the initial study of choice for ascites diagnosis?

A

A: Abdominal ultrasound.

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13
Q

Q: What laboratory test is essential in evaluating ascitic fluid?

A

A: Serum-ascites albumin gradient (SAAG).

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14
Q

Q: What does a SAAG value ≥ 1.1 g/dL suggest?

A

A: Portal hypertension-related ascites.

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15
Q

Q: Name one indication for diagnostic paracentesis.

A

A: New-onset ascites.

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16
Q

Q: What does a cloudy appearance of ascitic fluid suggest?

A

A: Infection or malignancy.

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17
Q
  1. Q: What is chylous ascites?
A

A: Triglyceride-rich lymph fluid in the abdominal cavity.

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18
Q

Q: What is hemorrhagic ascites?

A

A: Ascitic fluid with RBC count > 50,000/mm³.

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19
Q

Q: Name one cause of pancreatic ascites.
.

A

A: Acute pancreatitis

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20
Q

Q: What is the primary approach to managing ascites?

A

A: Treating the underlying condition.

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21
Q

Q: When is therapeutic paracentesis indicated?

A

A: For tense or large ascites.

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22
Q

Name a diuretic commonly used for ascites management.

A

A: Spironolactone.

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23
Q

What is the daily sodium restriction for ascites patients?

A

A: 2 g/day.

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24
Q

When is fluid restriction recommended?

A

A: When serum sodium is < 125 mEq/L.

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25
What is hepatorenal syndrome?
A: Acute, reversible renal failure in cirrhotic patients with ascites.
26
Name one trigger for hepatorenal syndrome.
A: Refractory ascites.
27
What is the first-line treatment for hepatorenal syndrome?
A: Vasopressin (e.g., terlipressin) and albumin.
28
Q: What is SBP?
A: Infection of ascitic fluid without a focal intraabdominal source.
29
29. Q: Which bacteria commonly cause SBP?
A: Escherichia coli and Klebsiella spp
30
Name two symptoms of SBP. .
A: Abdominal pain and fever
31
What neutrophil count in ascitic fluid indicates SBP?
A: ≥ 250/mm³.
32
What is the treatment for SBP?
A: Broad-spectrum IV antibiotics, such as cefotaxime.
33
Why should NSAIDs be avoided in cirrhotic ascites?
A: They worsen renal perfusion.
34
What is the role of albumin in therapeutic paracentesis?
A: Prevents postparacentesis circulatory dysfunction.
35
35. Q: What invasive procedure can be considered for refractory ascites?
A: Transjugular intrahepatic portosystemic shunt (TIPS).
36
What does a milky ascitic fluid indicate?
A: Chylous ascites.
37
What does a dark brown ascitic fluid suggest?
A: Biliary leak.
38
What protein concentration in ascitic fluid suggests cirrhosis?
A: < 2.5 g/dL.
39
Name a cause of ascites due to hypoalbuminemia.
A: Nephrotic syndrome.
40
What type of malignancy often causes peritoneal carcinomatosis? .
A: Ovarian carcinoma
41
What is a common infectious cause of ascites?
A: Tuberculosis.
42
Q: What is the role of serial abdominal examinations in SBP?
A: To monitor treatment response.
43
What is a key indicator of poor antibiotic response in SBP?
A: Less than 25% reduction in ascitic PMNs after 48 hours.
44
What is the difference between transudate and exudate in ascitic fluid?
A: Transudate is associated with portal hypertension (SAAG ≥ 1.1 g/dL), while exudate is due to other causes (SAAG < 1.1 g/dL).
45
Name two conditions that cause high protein levels (> 2.5 g/dL) in ascitic fluid.
A: Tuberculosis and peritoneal carcinomatosis.
46
Name a condition that causes low protein levels (< 2.5 g/dL) in ascitic fluid. .
A: Cirrhosis
47
What color of ascitic fluid suggests a traumatic or malignant etiology? .
A: Bloody
48
What is the definition of refractory ascites?
A: Ascites that does not respond to treatment or recurs after therapeutic paracentesis.
49
What dietary recommendation is essential in refractory ascites management?
A: Strict sodium restriction.
50
Name one invasive treatment option for refractory ascites.
A: Liver transplantation.
51
What is the median survival for patients with refractory ascites? .
A: About one year
52
What percentage of patients with advanced cirrhosis develop hepatorenal syndrome?
A: Approximately 10%.
53
Name a common complication of large-volume paracentesis.
A: Postparacentesis circulatory dysfunction (PPCD).
54
What is the most common bacterial infection in cirrhotic patients with ascites?
A: Spontaneous bacterial peritonitis (SBP).
55
What is the most common route of bacterial translocation in SBP?
A: Through the intestinal wall to the mesenteric lymph nodes.
56
Name one laboratory test critical for diagnosing SBP.
A: Ascitic fluid cell count and differential.
57
Why are ascitic fluid cultures often negative in SBP?
A: Due to the fastidious nature of the bacteria or low bacterial load
58
What adjunctive therapy improves outcomes in SBP?
A: IV albumin supplementation.
59
Name two risk factors that indicate the need for IV albumin in SBP patients.
A: Blood urea nitrogen > 30 mg/dL and total bilirubin > 5 mg/dL.
60
What is the role of TIPS in ascites management?
A: It reduces portal hypertension and improves ascitic fluid control.

Internal Medicine (3 decks)

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