10.6.1: Ascites Flashcards

1
Q

Clinical signs suggestive of ascites

A
  • (Depends on underlying cause):
  • Discomfort
  • Dyspnoea (pressure on diaphragm/concurrent pleural effusion)
  • Lethargy
  • O may describe: weight gain, difficulty getting up/lying down
  • Other signs: V+/D+, coughing, syncope
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2
Q

Causes of abdominal distension without effusion (ddx for ascites)

A
  • Organomegaly
  • Abdominal mass
  • Pregnancy
  • Bladder distension
  • Obesity
  • Gastric distension
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3
Q

Types of fluids seen in ascites

A
  • Protein-poor transudate
  • Protein-rich transudate
  • Exudate
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4
Q

Differential diagnoses for protein-poor transudate

A
  • Protein-losing enteropathy
  • Hepatic failure
  • Protein-losing nephropathy
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5
Q

Describe the pathophysiology of ascites with protein-poor transudate

A
  • There are altered fluid dynamics
  • May be due to marked decrease in albumin
  • There is decreased plasma colloid oncotic pressure for fluid leaks out
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6
Q

Key feature of exudate

A

High TNCC

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7
Q

Differential diagnoses for ascites with protein-rich transudate

A
  • Cardiovascular disease
  • Chronic liver disease e.g. post-hepatic portal hypertension
  • Neoplasia
  • Thrombosis
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8
Q

Describe the pathophysiology of protein-rich transudate

A
  • Increased hydrostatic pressure within blood and/or lymphatics (usually lungs or liver)
  • Protein leaks from permeable capillaries.
  • Ascites develops when resorptive capacity of regional lymphatics is overwhelmed
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9
Q

Differential diagnoses for septic exudate

A
  • Penetrating wound
  • Surgical complication
  • Rupture of infected lesion
  • Bacteraemia (rare)
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10
Q

Describe the pathophysiology of ascites with exudate

A
  • Inflammatory process (e.g. chemotactants and vasoactive substances) attract inflammatory cells and cause increased vascular permeability
  • High TNCC are neutrophils/other inflammatory cells
  • Can be septic or non-septic
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11
Q

Differential diagnoses for ascites with non-septic exudate

A
  • Neoplasia
  • Uroperitoneum
  • Bile peritonitis
  • FIP
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12
Q

Differential diagnoses for ascites for haemorrhagic effusion

A
  • Surgical and non-surgical trauma
  • Haemostatic defects
  • Neoplasia
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13
Q

Differential diagnoses for ascites with lymphatic compromised effusion (chylous or non-chylous)

A
  • Cardiac disease
  • Hepatic disease
  • Neoplasia
  • Steatitis
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14
Q

How would you investigate an ascites with suspected protein-poor transudate?

A
  • Biochemistry to assess albumin levels, renal parameters
  • Urinalysis to assess renal health
  • Ultrasound to locate fluid, assess abdo organs e.g. intestines, kidneys, liver
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15
Q

How would you investigate ascites with a suspected protein-rich transudate?

A
  • Ultrasound
  • Radiography (thoracic)
  • Biochemistry
  • Could assess total protein with refractometer
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16
Q

How would you investigate ascites with a septic exudate?

A
  • Abdominocentesis and assess appearance/smell of fluid
  • Cytology: observe numerous degenerate neutrophils ± intracellular bacteria
  • Culture and sensitivity
  • Assess lactate and glucose of exudate (compare to blood)
17
Q

How would you investigate ascites with a suspected non-septic exudate?

A
  • Abdominocentesis and appearance of fluid; green-gold material if bile peritonitis
  • Cytology: non-degenerate neutrophils, no bacteria presence
  • Biochemistry of exudate: High urea, creatinine, potassium if uroperitoneum
  • Ultrasound for location/potential cause of effusion e.g. ruptured gallbladder
18
Q

Neoplasia can produce a transudate/exudate/chylous/haemorrhagic effusion?

A

All of the above.
Neoplasias have variable characteristics and can cause a number of different effusions by different mechanisms