Ascites

Question 1

What is ascites?

Answer 1

Accumulation of fluid in the abdominal cavity

Question 2

What is the pathology of ascites?

Answer 2

• ↑ Na and water
• 75% due to portal hypertension
• Underfilling: Removal of fluid in the splanchnic vascular bed due to portal hypertention → ↓ blood volume → activating RAAS and Na and H20 retention
• Overflow: Inappropriate activation of RAAS
• Peripheral arterial vasodilation: portal hypertension = vasodilation = ↓ arterial blood volume. Na is retailed and plasma volume expands

Question 3

What are the risk factors/aetiology of ascites?

Answer 3

• Cirrhosis
• Malignancy
• Infection – esp. TB
• ↓ albumin
• Congestive cardiac failure
• Pericarditis
• Pancreatitis
• Myxoedema

Question 4

What are the signs and symptoms of ascites?

Answer 4

• Shifting dullness on abdominal examination
• Fluid thrills – for large ascites
• Abdominal distension
• Pain in abdomen
• Nausea
• Appetite suppression
• Dyspnoea – due to pressure
• Hernia – pushed out due to pressure
• Signs of liver disease if cause

Question 5

What diseases present similarly to ascites?

Answer 5

• Other causes of abdominal mass

Question 6

What investigations are conducted when ascites are investigated?

Answer 6

•	Measurement of abdominal girth/weight
•	FBC 
•	Renal function tests
•	LFTs - increased albumin
•	Clotting screen
•	TFTs
Aspiration microscopy
Amylase - rule out pancreatitis 
•	Abdominal ultrasound

Question 7

What are the surgical treatments for ascites?

Answer 7

• Paracentesis – needle inserted into the peritoneal cavity to obtain ascites fluid
• Transjugular intrahepatic portosystemic shunt (TIPS)

Question 8

What are the pharmacological treatments for ascites?

Answer 8

• Diuretics – spironolactone is 1st line

* Palliative care

Question 9

What are the non pharmacological treatments for ascites?

Answer 9

• Restricted salt intake