Ascites

Question 1

Serum ascites albumin gradient more than 11g/l (portal hypertension) causes?

Answer 1

cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
right heart failure
constrictive pericarditis
budd chiari syndrome (Hepatic veins are blocked)
portal vein thrombosis
veno-occlusive disease
myoxedema

Question 2

Serum ascites albumin gradient less then 11g/l causes?

Answer 2

hypoalbuminaemia (oncotic pressure)
this could be due to nephrotic syndrome or severe malnutrition kwashikor

maliganacy- peritoneal carcinomatosis

infections- TB peritonitis
pancreatitis
bowel obstruction
biliary ascitis
postoperative lymphatic leak
serositis in connective tissue disease

Question 3

how to manage ascites?

Answer 3

1.reduce dietary sodium
2. fluid restriction if Na is less than 125mmol/l
3. aldosterone antagonist (spironolactone)
4. loop diuretics
5. paracentesis (albumin cover)
6. prophylactic antibiotics (ciprofloxacin or norfloxacin for people with cirrhosis and ascites with protein of 15g/litres or less)
7. TIPS