Ascites

Question 1

What is ascites?

Answer 1

Ascites describes the accumulation of fluid within the peritoneal cavity. It may be seen in patients with cirrhosis

Question 2

What investigation would you do to determine the cause of ascites?

Answer 2

Ascites tap to investigate ascitic fluid for serum ascites albumin gradient

(It is calculated by subtracting the albumin concentration of the ascitic fluid from the serum albumin concentration.)

Question 3

What are the causes of ascites due to high SAAG?

Answer 3

Cirrhosis
Heart failure
Budd Chiari syndrome
Constrictive pericarditis
Hepatic failure

A high SAAG (>1.1g/dL) suggests that the cause of the ascites is due to raised portal pressure. Raised hydrostatic pressure forces water into the peritoneal cavity whilst albumin remains within the vessels, thus resulting in a higher difference in the albumin concentration between the serum and ascitic fluid.

Question 4

What are the causes of ascites due to low SAAG?

Answer 4

Cancer of the peritoneum
Tuberculosis and other infections
Pancreatitis
Nephrotic syndrome

Question 5

How would you manage ascites?

Answer 5

Address the underlying cause
Salt restricted diet
Fluid restriction
Spironolactone
Adjunctive diuretic therapy such as furosemide may be needed if spironolactone is insufficient.