Ascites

Question 1

Ascites

Answer 1

Abnormal accumulation of fluid in the abdomen

Question 2

SAAG

Answer 2

Serum-ascites albumin gradient

Question 3

SAAG >11g

Answer 3

Indicates portal hypertension

Question 4

Causes of ascites with SAAG >11

Answer 4

Liver disorders most common
- cirrhosis/ alcoholic liver disease
- acute liver failure
- liver metastases

Cardiac
- right heart failure
- constrictive pericarditis

Other causes
- Budd-Chiari syndrome
- portal vein thrombosis
- veno-occlusive disease
- myxoedema

Question 5

Causes of ascites with SAAG <11g

Answer 5

Hypoalbuminaemia
- nephrotic syndrome
- severe malnutrition

Malignancy
- peritoneal carcinomatosis

Infections
- tuberculous peritonitis

Other causes
- pancreatitis
- bowel obstruction
- biliary ascites
- postoperative lymphatic leak
- serositis in connective tissue disease

Question 6

Management

Answer 6

Reduce dietary sodium

Fluid restriction if sodium <125mmol/L

Aldosterone antagonists

Drainage if tense ascites

Transjugular intrahepatic portosystemic shunt may be considered

Question 7

Large-volume paracentesis

Answer 7

Requires albumin ‘cover’

Reduces paracentesis-induced circulatory dysfunction (can occur if >5L)

Question 8

Paracentesis induced circulatory dysfunction

Answer 8

High rate of ascites recurrence

Development of hepatorenal syndrome

Dilutional hyponatraemia

High mortality rate

Question 9

Prophylactic antobiotics

Answer 9

Oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein <15g until ascites has resolved