10.6.1: Ascites Flashcards
Clinical signs suggestive of ascites
- (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
Causes of abdominal distension without effusion (ddx for ascites)
- Organomegaly
- Abdominal mass
- Pregnancy
- Bladder distension
- Obesity
- Gastric distension
Types of fluids seen in ascites
- Protein-poor transudate
- Protein-rich transudate
- Exudate
Differential diagnoses for protein-poor transudate
- Protein-losing enteropathy
- Hepatic failure
- Protein-losing nephropathy
Describe the pathophysiology of ascites with protein-poor transudate
- There are altered fluid dynamics
- May be due to marked decrease in albumin
- There is decreased plasma colloid oncotic pressure for fluid leaks out
Key feature of exudate
High TNCC
Differential diagnoses for ascites with protein-rich transudate
- Cardiovascular disease
- Chronic liver disease e.g. post-hepatic portal hypertension
- Neoplasia
- Thrombosis
Describe the pathophysiology of protein-rich transudate
- 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
Differential diagnoses for septic exudate
- Penetrating wound
- Surgical complication
- Rupture of infected lesion
- Bacteraemia (rare)
Describe the pathophysiology of ascites with exudate
- 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
Differential diagnoses for ascites with non-septic exudate
- Neoplasia
- Uroperitoneum
- Bile peritonitis
- FIP
Differential diagnoses for ascites for haemorrhagic effusion
- Surgical and non-surgical trauma
- Haemostatic defects
- Neoplasia
Differential diagnoses for ascites with lymphatic compromised effusion (chylous or non-chylous)
- Cardiac disease
- Hepatic disease
- Neoplasia
- Steatitis
How would you investigate an ascites with suspected protein-poor transudate?
- Biochemistry to assess albumin levels, renal parameters
- Urinalysis to assess renal health
- Ultrasound to locate fluid, assess abdo organs e.g. intestines, kidneys, liver
How would you investigate ascites with a suspected protein-rich transudate?
- Ultrasound
- Radiography (thoracic)
- Biochemistry
- Could assess total protein with refractometer