Ascites

Question 1

ascites

Answer 1

excess accumulation of fluid in the peritoneal cavity; third spacing example

Question 2

etiology

Answer 2

• cirrhosis + portal HTN
• R-sided HF
• severe changes in CHP or OP
• water/Na retention

Question 3

how does cirrhosis + portal HTN causes ascites

Answer 3

non-functional fibrous tissue compresses vessels in the hepatic portal system leading to portal HTN –> inc in CHP in these vessels –> fluid shift occurs

Question 4

how does R-sided HF cause ascites

Answer 4

R-sided HF causes congestion within R-side of heart and blood back up into systemic circuit. inc blood vol in vessels within abd organs –> inc CHP –> fluid shifts into interstitial spaces of abd organs –> abd organ distention –> fluid shifts into abd cavity = ascites

Question 5

how do severe changes in CHP or OP cause ascites

Answer 5

• an inc in CHP or dec in OP –> ascites

- change in OP = proteinuria, fluid vol excess, liver failure

Question 6

how does water/na retention cause ascites

Answer 6

water/na retention causes inc in blood vol –> inc CHP –> fluid shifts

Question 7

mnfts

Answer 7

• dyspnea

- abdominal distention

Question 8

why does dyspnea manifest

Answer 8

accumulation of fluid inc pressure within abd cavity –> impedes movement of diaphragm to inc vol of thoracic cavity to expand lungs

Question 9

why does abdominal distention manifest

Answer 9

inc fluid in abd cavity results in distended abd

• pt lying flat has round abd and fluid on the side of abd
• pt stands up fluid flows downwards and abd rounded in lower region

Question 10

tx

Answer 10

• small vol: diuretics and sodium restriction
• fluid and electrolytes
• large vol: paracentesis

Question 11

why diuretics and sodium restriction used

Answer 11

• diuretics: to inc fluid loss to dec blood vol –> dec CHP in blood –> stop fluid from shifting from intravascular space into peritoneal space
• sodium restriction: dec blood vol (same action

Question 12

paracentesis

Answer 12

involves aspirating fluid out of cavity w/ needle