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GI > Ascites > Flashcards

Ascites Flashcards

1
Q

What is the MCC of ascites?

A

Portal HTN + Cirrhosis

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2
Q

What is the portal triad?

A

Bile duct
Interlobular vein
Branch of hepatic artery

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3
Q

Acute inflammation from trauma is ______. Ascites is _______.

A. Transudative; Exudative
B. Exudative; Transudative

A

Acute inflammation = Exudative
Ascites = Transudative

Exudative fluid contains proteins; transudative does not (translucent = clear)

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4
Q

hydrostatic vs oncotic pressure

A
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5
Q

SS of Ascites

A
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6
Q

Anasarca

A

generalized swelling

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7
Q

SS of chronic liver dz

A
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8
Q

Dx test of choice for pts with:
* new onset ascites
* sussy Malignant Ascites
* sussy Spon Bac Peritonitis

A

Paracentesis

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9
Q

What is a Transjugular intrahepatic portosystemic shunt (TIPS)

A

shunt from portal system to systemic veins

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10
Q

What is a peritoneovenous shunt?

A

shunt from peritoneal cavity to SVC

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11
Q

What is Budd-Chiari syndrome?

A

Hepatic vein clot

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12
Q

Who gets a hepatic vein clot (budd-chiari syndrome)?

A

35yo F on birth control

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13
Q

MCC of Budd-Chiari Syndrome?

A

Idiopathic

others: easy clotter (estrogen, smoker, pregnancy, BC)

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14
Q

What is the Virchows Triad that causes Budd-Chiari Syndrome?

A
  1. Hypercoagulable state (smoker)
  2. Endothelial Injury (clot forms)
  3. Blood Flow Stasis (Cells die)
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15
Q

Study of choice for Budd-chiari syndrome?

A

Doppler US

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16
Q

What to do for hepatic vein clot thats less than 4wks old?

A

Anticoagulants

17
Q

Trmnt for hepatic vein clot thats > 4 wks old?

A

Vascular consult for angioplasty or TIPS

Transjugular Intrahepatic Portosystemic Shunt (TIPS) = shunt from portal system to IVC

18
Q

Where does the bacteria in spon bac peritonitis come from?

A

Bac travel from intestines -> mesenteric lymph nodes -> ascites fluid

19
Q

What can spon bac peritonitis do to your bowels?

A

it can cause an ilieus (acidic fluid irritates the bowels)

20
Q

Risks for spon bac peritonitis?

A

MC: Cirrhosis, Ascites
* ascitic fluid total protein <1g/dL
* prior episode of Small bowel Perf
* Sertume total Bilirubin >2.5mg/dL
* Variceal hemorrhage
* Malnutrition
* PPI use (not enough acid to kill bac)

21
Q

ABX for spon bacterial peritonitis?

A

Pipercillin-Tazobactam IV
Ceftriaxone IV
Ertapenem IV
PCN Allx -> quinolone (Cipro, Leva)

IV ABX for 5+ days

22
Q

Trmnt for spon bac peritonitis?

A
  • GI specific IV ABX for 5+ days
  • IV Albumin (reduces risk of renal failure, improves survival)

GI (19 decks)

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