Ascites

Question 1

Description: What is ascites?

Answer 1

Presence of fluid in the peritoneal cavity

Question 2

Aetiology/ Risk factors: What are the causes of ascites when the serum ascites albumin gradient (SAAG) > 1.1g/dL?

Answer 2

Serum Ascites Albumin Gradient (SAAG) > 1.1 g/dL:

• Congestive heart failure
• Constrictive pericarditis
• Budd Chiarri
• Massive liver metastasis
• Myxedema
• Portal hypertension

Question 3

Aetiology/ Risk factors: What are the causes of ascites when the serum ascites albumin gradient (SAAG) < 1.1g/dL?

Answer 3

Serum Ascites Albumin Gradient (SAAG) < 1.1 g/dL

• Malignancy
• Tuberculosis
• Pancreatitis
• Nephrotic syndrome
• Serositis
• Biliary ascites
• Chylous ascites

Question 4

PATHOLOGY NOT IN THE LECTURE

Answer 4

PATHOLOGY NOT IN THE LECTURE

Question 5

SYMPTOMS NOT IN THE LECTURE

Answer 5

SYMPTOMS NOT IN THE LECTURE

Question 6

Signs: On clinical examination, what are the signs of a patient with ascites?

Answer 6

• Flank dullness and shifting dullness (on percussion)

Corresponding evidence for ascites diagnosis:

• Palmar erythema
• Umbilical nodule
• JVP elevation
• Abdominal veins
• Spider naevi
• Fetor hepaticus

Question 7

Investigations: How do we investigate ascites?
(a) First line investigation of a patient with new-onset ascites (1)

(b) Routine ascitic fluid tests. (3)
(c) Optional ascitic fluid tests. (5)
(d) Imaging investigations. (1)

Answer 7

(a) - Diagnostic paracentesis (drainage/
aspiration)

(b) Analyse the following ascitic fluids:
- Cell count
- Albumin
- Protein

(c) Optional:
- Glucose
- Amylase
- LDH
- Culture
- Gram stain

(d) - Ultrasound scan (can assess ascites and show the cause)

Question 8

Treatment: What are the treatment options for a patient with ascites? (5)

Answer 8

• Diuretics
• Large volume paracentesis
• Transjugular intrahepatic portosystemic shunt (TIPS)
• Aquaretics (promote excretion of water)
• Liver transplant