Ascitis Flashcards
(27 cards)
Mc comp of cirrhosis
Ascitis (Poor prognosis)
Ascitis grading (imp)
A)Grade I
Only detectable by USS
B)Grade II Moderate symmetrical enlargement
shifting dullness
C)Grade III Marked abdominal enlargement – transmitted thrill
diagnostic paracentesis INDICATIONS
1)with new onset grade 2 or 3 ascites,
2) all patients hospitalized for worsening of ascites
3) any complication of cirrhosis
SAAG(IMP)
> 1.1 indicates portal hypertension
Total PTN with portal HTN related ascitis
.
● < 2.5 g/dL: cirrhotic ascites.
● ≥ 2.5 g/dL: cardiac ascites (congestive heart failure, )
or Budd-Chiari $
Total PTN with non portal HTN related Ascitis
● < 2.5 g/dL: nephrotic ascites.
● ≥ 2.5 g/dL: peritoneal carcinomatosis, tuberculous Ascitis
TTT of Ascitis
Salt restrictions
diuritics( in G2,3)
Large volume paracentesis( in G 3)
Fluid restriction
only indicated in
hypervolemic patients with serum Na
less than 125 mmol.
Salt restriction
intake of
sodium of 80–120 mmol/day, This is generally
equivalent to a no added salt diet with avoidance of
pre-prepared meals.
Diuritics of choice
2)dose
Aldosterone antagonists(spironolactone)
2)100-400 increasing stepwise
every 3 days (in 100 mg steps)
When to add fursomide
2)dose
1)no response(<2kg/w)
2)40-160(increasing stepwise 40 mg steps).
Discontinuation
1)general
2)fursamide
3)spironolactone
1) severe hyponatremia (<120 mmol/L),
progressive renal failure, , or
incapacitating muscle cramps.
2) severe hypokalemia (<3 mmol/L).
3)severe hyperkalemia(>6)
LVP means (TTT of choice with grade 3)
Drain 5 litres of ascitic fluid at
one session
REQIURE DIURITICS TTT AFTER WHICH
PPCD(post-paracentesis circulatory dysfunction)
PREVENTION
administration of albumin, (6-8 g/L)
REFRACTORY ASCITIS
1 (median survival )
2 CAUSES
6M
2) SBP, HRS, severe hyponatremia,pvt and HCC
DIAGNOSIS OF REFRACTORY ASCITIS
weight loss of <0.8 kg over 4 day
intensive diuretic therapy (spironolactone 400 mg/day and furosemide 160 for at least 1 week)
salt-restricted diet of less than 90 mmol/day
Reappearance of grade 2 or 3 ascites within 4 weeks of initial mobilization
Diuritics induced complications
Maximum weight loss during diuretic therapy
No edema 0.5 kg/day
1 kg/day in patients with edema.
Refractory ascitis TTT
i. LVP plus albumin
ii. Diuretics: not effective,
iii. Liver transplantation
iv. TIPSS:
MC cause of SBP
E COLI
if positive pneumococcus. And enterococcus
SBP neutrophilic count
> 250
SBP TTT
1ST line first line third-gen cephalosporins.
Alternative Amoxicillin/clavulanic acid
and quinolones such as ciprofloxacin.(30% resistant to quinolones)
SBP RF
acute GIT hemorrhage
(2) low total PTN in ascitic fluid
and no prior history of SBP
(3) history oF SBP
Most IMP RF OF HRS
SBP
HRS TTT
ALBUMIN
VC(TERLIPRESSIN EHE BEST)
Liver trans(choice in grade 1,2)
Renal replacement
