Ascites

Question 1

Definition

Answer 1

Collection of fluid in peritoneal cavity

Question 2

Etiology

Answer 2

Hepatitis C
Alcoholic hepatitis
CHF
Nephrotic syndrome
Pancreatitis

Other causes of cirrhosis
Schistosomiasis
Constrictive pericarditis
Ovarian tumors
SLE
Protein losing enteropathy

Question 3

History

Answer 3

Presence/risks of cirrhosis
Risks of hepatitis C
Family history
SOBOE, PND, orthop->CHF
Malignancy
Pancreatitis
Autoimmune disease

Question 4

Physical examination

Answer 4

General
Stigmata of cirrhosis
JVP distension
Abdominal
Peripheral edema

Question 5

Investigations

Answer 5

USS
FBC, LFT, UEC, albumin
Coagulation
Calculate MELD/Chigh Pugh
Serology for hepatitis B, A, C->determine status and need for immunisations
Abdominal paracentesis->cell count, differential, albumin, protein, culture, glucose, LDH, amylase, gram stain, TB smear/culture, cytology
Liver biopsy

Question 6

What in the ascitic fluid suggests non-cirrhotic cause

Answer 6

ascitic fluid albumin gradient is high
Diagnosis based on SAAG:
>1.1g/dL: portal hypertension
Cirrhosis
Portal vein thrombosis
Budd chiari
CHF
Corrective pericarditis

Question 7

Risks with paracentesis

Answer 7

Hematoma 1%