Ascites Flashcards
Ascites
Accumulated free fluid in the abdomen cavity, complication of cirrhosis
Risk factors
High sodium diet
HCC
Splanchnic vein thrombosis = portal hypertension
Aetiology
Anything leading to portal HTN:
- CIRRHOSIS = MC
- raised pressure in vessels causing fluid to leak out
- Budd-Chiari syndrome
- Portal HTN
- RSHF
- Constrictive pericarditis
Local inflammation:
- Peritonitis
- TB
- Abdo cancer (ovarian esp.)
Low protein:
- nephrotic syndrome
- hypoalbuminaemia (liver failure)
Pathophysiology
Excessive build-up of fluid in the peritoneal cavity.
Poor liver function = low albumin - low blood oncotic pressure
Leads to fluid loss to the peritoneal cavity. Due to portal HTN fluid can leak out of the capillaries in the liver + bowel + into the peritoneal cavity.
The drop in circulating volumes cause by fluid loss causes a reduction of BP entering the kidneys’. Consequently the kidneys release renin which causes aldosterone secretion and re-absorption of fluid + Na+ in the kidneys.
Signs + Symptoms
Abdominal distention
Shifting dullness = classic sign, percuss abdomen + observe dullness over fluid versus resonance over air. Ask patient to roll onto one side + repercuss on the side = resonant
Protruding ascites
Flank dullness
Fluid thrill
Bulging flanks
May have jaundice + pruritus
Risk of SBP
Types of fluid
Transudate = clear fluid, due to increased hydrostatic pressure
- portal htn, budd-chiari, constrictive pericarditis, C.H.F, nephrotic syndrome
<30g/L protein (low),
<11g/L serum albumin ascitic gradient
Exudate = cloudy fluid, fluid due to inflammation mediated exudation or low oncotic pressure
- malignancy, peritonitis, pancreatitis
>30g/L protein (high)
>11g/L SAAG
Diagnosis
Shifting dullness on exam (+ flank fullness + fluid thrill)
Ascitic tap (peritocentesis of 10-20ml fluid)
1. cytology (wcc counts)
2. protein measurement
Treatment
Treat underlying cause
Low sodium diet <200mg/day
Spironolactone + Furosemide (diuretics) to drain fluid
Paracentesis
Liver transplant
Complications
SBP
