Abdo Distention (Mod 202) Flashcards
What are the 6 F’s to think about for abdo distention?
Flatus, Fat, Fluid, Fetus, Feces, Fatal Growth
What is a ddx for ascites
cirrhoses, ca, heart failure, TB, dialysis, pancreatic disease
What is the pathophys of ascites in portal HTN?
- MUST have portal HTN to have ascites 2. portal pressure >12mmHg required for fluid retention 3. portal HTN = profound changes in splachnic circulation (vasodilation and hyper dynamic circulation)
What are the consequences of vasodilation in portal htn
activation of endogenous vasoconstrictors. Na+ retention, h20 retention, renal vasoconstriction
What is the chain of events once portal htn is established that lead to ascites?
portal HTN> increase NO > vasodilation > renal Na retention > increase intravasc volume > ascites > increase sympathetic stun, renin, aldosterone > renal Na retention (ongoing circle)
What are the 4 consequences of vasodilation secondary to increased nitric oxide in portal htn
activation of endogenous vasoconstrictor agents, na+ retention, H20 retention, renal vasoconstriction
what are the 4 broad categories of pathogenesis of fluid retention?
circulatory, vascular, functional, biochemical
What are 7 causes of circulatory fluid retention?
reduce SVR, reduced arterial pressure, increased HR, increased cardiac index, increased plasma volume, reduced renal blood flow, increased portal blow flow
What are 3 vascular causes of fluid retention
splanchnic vasodilation, renal artery vasoconstriction, pulmonary vasodilation
What are 4 causes of functional fluid retention
activation of systemic vasodilator factors, activation of systemic vasoconstrictor factors, activation of renal vasodilator factors, reduced GFR
What are 5 biochemical causes of fluid retention
Na, H20, ^ NO, ^ renal NO, ^ prostaglandins
