Ascites

Question 1

What is ascites?

Answer 1

Abnormal accumulation of fluid in the abdomen

Question 2

What medication would you give to a liver cirrhosis patient presenting with ascites?

Answer 2

Spironolactone (aldosterone antagonist) - combats sodium retention in fluid

Question 3

How is ascites causes grouped?

Answer 3

Whether the serum-ascites albumin gradient (SAAG) is <11g/L or >11g/L

Question 4

What does SAAG >11g/L indicate?

Answer 4

Portal hypertension

Question 5

Most common causes of SAAG >11g/L

Answer 5

liver disorders:

• cirrhosis/alcoholic liver disease
• acute liver failure
• liver mets

Question 6

Cardiac causes of SAAG >11g/L

Answer 6

• right HF

- constrictive pericarditis

Question 7

Causes of SAAG <11g/L and hypoalbuminaemia?

Answer 7

(1) nephrotic syndrome

2) severe malnutrition (Kwashiorkor

Question 8

Malignant cause of SAAG <11g/L

Answer 8

Peritoneal carcinomatosis

Question 9

Infectious cause of SAAG <11g/L

Answer 9

• Tuberculosus perintonitis

- Pancreatitis

Question 10

Other causes of SAAG >11g/L ascites?

Answer 10

• bowel obstruction
• biliary ascites
• post-op lymphatic leak
• serositis in connective tissue disease

Question 11

Management if hyponatreamic?

Answer 11

Restrict fluids if <125

Question 12

If first episode of ascites, how would you manage alcoholic liver disease in the community?

Answer 12

(1) Quit alcohol

(2) Nutrition - low sodium, high protein

Question 13

Signs that indicate ascites has progressed to SBP?

Answer 13

• fever
• abdominal pain
• distension
• -> IV ceftriaxone, prophylactic if GI bleeding

Question 14

What can you give to reduce mortality risk when performing large volume paracentesis?

Answer 14

IV Human Albumin solution