ascites

Question 1

what is ascites?

Answer 1

• abnormal accumulation of fluid within the abdominal cavity
• complication of cirrhosis

Question 2

what are the types of causes of ascites?

Answer 2

1. local inflammation
2. low protein
3. flow stasis- impaired blood flow

Question 3

what can cause local inflammation in ascites?

Answer 3

• peritonitis
• TB
• Abdo cancer

Question 4

what can cause low protein in ascites?

Answer 4

• nephrotic syndrome
• hypoalbunimia
  -malnutrition

Question 5

what can cause flow stasis in ascites?

Answer 5

• cirrhosis
• budd chiari
• constructive pericarditis
• cardiac failure

Question 6

why does low protein cause ascites?

Answer 6

with low protein, you can’t pull fluid back to intra- vascular space therefore accumulates in peritoneum

Question 7

why does flow stasis cause ascites?

Answer 7

fluid can’t move through the system and therefore increases pressure therefore fluids leaks out of vessels

Question 8

what are the symptoms of ascites?

Answer 8

• abdo- distension ( risk of SBP)
• shifting dullness ( fullness in flanks and fluid thrill)
• jaundice and prutitus

Question 9

describe how you do the shifting dullness test?

Answer 9

1. tap on central abdomen when supine= resonant- bowel floats
   tap on flanks= dull due to fluids
2. ask patient to lay on side and tap flank= resonant
   —-as fluid has shifted to other side and bowel floated here

Question 10

how is ascites diagnosed?

Answer 10

1. shifting dullness on exam
2. ascitic tap ( paracentesis of 10-20 ml of fluid)

Question 11

what are the two types of ascitic taps?

Answer 11

• cytology WCC
• protein measurement
  —-transudate
  or
  — exudate

Question 12

describe the transudate ascitic tap

Answer 12

< 30 g/L protein ( low), SAAG is < 11g/L
- clear fluid
- fluid due increases hydrostatic pressure

Question 13

describe the exudate ascitic tap

Answer 13

> 30g/L protein ( high), SAAG is > 11g/L ( or equal to)- serum ascites albumin gradient- assesses extent of ascites
- cloudy fluid
-fluid due to inflammation mediated exudation or low oncotic pressure

Question 14

how are ascites treated?

Answer 14

• treat underlying cause
• diuretic- to increase sodium excretion therefore more fluid flushed out- spironolactine
• paracentesis- drain fluid
• liver transplant