Abdominal Enlargement - Ascites

Question 0

Amount of fluid to be considered ascites

Answer 0

> 25mL

Question 1

Amount of fluid needed to test positive for shifting dullness

Answer 1

1.5L

Question 2

Factors important in ascites formation

Answer 2

Increased total body Na and water
Increased sinusoidal portal pressure
Menstruation

Question 3

Pathogenesis of Ascites

Answer 3

Underfill theory
Overflow theory
Peripheral Arterial Vasodilation theory

Question 4

Types of Ascites

Answer 4

Uncomplicated: responds to diuretics
Refractory: persistent, not controlled by sodium restriction and maximal diuretic therapy
Malignant: painful ascites

Question 5

Grading of ascites

Answer 5

Grade 1 - detectable only by UTZ
Grade 2 - symmetrical distention of abdomen
Grade 3 - respiratory distress, gradual enlargement

Question 6

Ascitic fluid analysis: inspection

Answer 6

Transparent, yellow-tinged ➡️ cirrhosis

Blood-tinged, non-clotting ➡️ malignancy

Question 7

SAAG

Answer 7

Serum Ascitic Albumin Gradient

= serum albumin - ascitic fluid albumin

Question 8

> or = 1.1 –> TRANSUDATIVE (cirrhosis)

< 1.1 –> EXUDATIVE

Answer 8

Yes

Question 9

When ascites is painful, consider these

Answer 9

Spontaneous bacterial peritonitis
Superimposed malignancy
Pancreatitis

Question 10

Ascites Treatment: non-pharmacologic

Answer 10

Bed rest

Diet (sodium/fluid restriction)

Question 11

Ascites Treatment: pharmacologic

Answer 11

Spironolactone
Furosemide
Large volume paracentesis + albumin infusion