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Clinical Alimentary System > 3.4. Liver + Biliary Tree Disease - Ascites and Spontaneous Bacterial Peritonitis > Flashcards

3.4. Liver + Biliary Tree Disease - Ascites and Spontaneous Bacterial Peritonitis Flashcards

1
Q

What are the causes of Ascites divided into?

A
  1. Haemorrhagic Ascitic Fluid
  2. Chylous (Milky) Ascitic Fluid
  3. Straw-Coloured Ascitic Fluid
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2
Q

What are the causes of a Haemorrhagic Ascitic Fluid?

A
  1. Malignancy
  2. Abdominal Trauma (e.g. Ruptured Exctopic Pregnancy)
  3. Acute Pancreatitis
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3
Q

What are the causes of a Chylous (Milky) Ascitic Fluid?

A

Cirrhosis / Obstruction of the main Lymphatic Duct

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4
Q

What are the causes of a Straw-Coloured Ascitic Fluid?

A
  1. Liver conditions
  2. Infections
  3. Systemic Conditions
  4. Congenital Syndromes
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5
Q

What Liver Conditions can cause Straw-Coloured Ascitic Fluid?

A
  1. Malignancy
  2. Cirrhosis
  3. Hepatic Vein Obstruction
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6
Q

What Infections can cause Straw-Coloured Ascitic Fluid?

A
  1. Tuberculosis

2. Following Intra-abdominal perforation (e.g. E. Coli)

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7
Q

What does Intra-Abdominal Perforation usually end up causing?

A

Spontaneous Bacterial Peritonitis

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8
Q

What Systemic Conditions can cause Straw-Coloured Ascitic Fluid?

A
  1. Chronic Pancreatitis

2. Congestive Heart Failure

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9
Q

What Congenital Syndromes can cause Straw-Coloured Ascitic Fluid?

A
  1. Meigs’ Syndrome

2. Nephrotic Syndrome

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10
Q

What is Ascites?

A

Fluid within the Peritoneal Cavity

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11
Q

What is Ascites a common complication of?

A
  1. Cirrhosis

2. Renal Sodium and Water Retention (Secondary to this)

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12
Q

What is the Mechanism for Renal Sodium and Water Retention?

A
  1. Urine excretion is low due to the Renal Aetiology

2. This results in a Positive Sodium Gradient (so more water is retained)

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13
Q

What causes the Sodium and Water Retention in the Kidney?

A
  1. Peripheral Arterial Vasodilation occurs (reducing the effective blood volume)
  2. This creates the sensation of Hypotension, which activates the RAAS system of the Kidneys to retain more Sodium and Water
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14
Q

What is the effect of Portal Hypertension on Ascitic Fluid Build-Up?

A
  1. This exerts a local hydrostatic pressure, which leads to the increased Hepatic and Splanchnic production of Lymph (and Transudate)
  2. The excess production of Lymph (and Transudate) then begins to leak and fill up the Peritoneal Cavity
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15
Q

What is the effect of Low Serum Albumin on Ascitic Fluid Build-Up?

A
  1. Due to the poor Liver Synthesis of Albumin, there is Hypoalbuminaemia
  2. Hypoalbuminaemia results in a loss of Oncotic pressure, so there is a Greater Hydrostatic pressure pushing the water out into the Peritoneal Cavity
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16
Q

What is the Pathology of Spontaneous Bacterial Peritonitis?

A

The infecting organisms enter into the peritoneum via haematological spread

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17
Q

What are the Clinical Features of Ascites / Spontaneous Bacterial Peritonitis?

A
  1. Abdominal Swelling
  2. Abdominal Pain
  3. Respiratory Distress
  4. Pyrexia
  5. Infectious Markers
18
Q

Why does the Abdominal Swelling occur?

A

Due to the fluid being present in the Paritoneal Cavity

19
Q

How does the Abdominal Swelling present?

A

As a shifting Dullness

20
Q

How severe is the pain in Ascites?

A

Mild - it is more of a Discomfort

21
Q

How sever is the pain in Spontaneous Bacterial Peritonitis?

A

Severe

22
Q

Why can Respiratory Distress occur?

A

Due to the potential Right Sided Pleural Effusion, which can occur due to the Livers proximity

23
Q

When does Pyrexia and other Infectious Markers occur?

A

In cases of Spontaneous Bacterial Peritonitis, due to the infection

24
Q

What investigations are needed for Ascites / Spontaneous Bacterial Peritonitis?

A

Diagnostic Aspiration

25
Q

What is included in the Diagnostic Aspiration?

A
  1. White Cell Count
  2. Gram Stain and Culture
  3. Protein Count
  4. Cytology
  5. Amylase
26
Q

Why is the White Cell Count of the Ascitic Fluid examined

A

To deduce is it is Spontaneous Bacterial Peritonitis

27
Q

Why is there a Gram Stain and Culture?

A

For Bacteria and Acid’Fast Bacilli - to deduce if it is Spontaneous Bacterial Peritonitis

28
Q

Why is there a Protein Count?

A

To assess the causation of the Ascites

29
Q

What does a High Serum-Albumin Gradient of the Ascitic Fluid suggest?

A

The cause is Portal Hypertension

30
Q

What does a Low Serum-Albumin Gradient of the Ascitic Fluid suggest?

A

The cause is Peritoneal Abnormalities

31
Q

Why is Cytology needed?

A

To assess for Malignant Cells

32
Q

Why is Amylase tested for?

A

To exclude Pancreatic Ascites

33
Q

What is the Treatment of Ascites?

A
  1. Reduce Sodium Intake
  2. Diuretics
  3. Paracentesis
  4. Transjugular Intrahepatic Portocaval Shunting
  5. Antibiotics
34
Q

What is the purpose of reducing the dietary Sodium?

A

As this helps tackle the initial problem of Sodium Retention causing excess Water retention

35
Q

Why are Diuretics used?

A

Aldosterone Antagonists are used to reduce the Salt-Water Re-absorption (and hence retention)

36
Q

What is Paracentesis?

A

The Perforation and Drainage of the Ascitic Fluid from the Peritoneal Cavity

37
Q

When is Paracentesis used?

A

When the Diuretics are not effective enough

38
Q

What is the function of Paracentesis?

A

Symptomatic Relief

39
Q

When would a Transjugular Intrahepatic Portocaval Shunt be used?

A

When appropriate, if Portal Hypertension was the cause

40
Q

When would Antibiotics be used?

A

To treat the Spontaneous Bacterial Peritonitis

41
Q

Which type of Antibiotic is used?

A

Treatment - 3rd Generation Cephalosporin

Prophylaxis - Quinolone

Clinical Alimentary System (64 decks)

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