Ascites

Question 1

What is the MCC of ascites?

Answer 1

Portal HTN + Cirrhosis

Question 2

What is the portal triad?

Answer 2

Bile duct
Interlobular vein
Branch of hepatic artery

Question 3

Acute inflammation from trauma is ______. Ascites is _______.

A. Transudative; Exudative
B. Exudative; Transudative

Answer 3

Acute inflammation = Exudative
Ascites = Transudative

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

Question 4

hydrostatic vs oncotic pressure

Answer 4

Question 5

SS of Ascites

Answer 5

Question 6

Anasarca

Answer 6

generalized swelling

Question 7

SS of chronic liver dz

Answer 7

Question 8

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

Answer 8

Paracentesis

Question 9

What is a Transjugular intrahepatic portosystemic shunt (TIPS)

Answer 9

shunt from portal system to systemic veins

Question 10

What is a peritoneovenous shunt?

Answer 10

shunt from peritoneal cavity to SVC

Question 11

What is Budd-Chiari syndrome?

Answer 11

Hepatic vein clot

Question 12

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

Answer 12

35yo F on birth control

Question 13

MCC of Budd-Chiari Syndrome?

Answer 13

Idiopathic

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

Question 14

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

Answer 14

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

Question 15

Study of choice for Budd-chiari syndrome?

Answer 15

Doppler US

Question 16

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

Answer 16

Anticoagulants

Question 17

Trmnt for hepatic vein clot thats > 4 wks old?

Answer 17

Vascular consult for angioplasty or TIPS

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

Question 18

Where does the bacteria in spon bac peritonitis come from?

Answer 18

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

Question 19

What can spon bac peritonitis do to your bowels?

Answer 19

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

Question 20

Risks for spon bac peritonitis?

Answer 20

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)

Question 21

ABX for spon bacterial peritonitis?

Answer 21

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

IV ABX for 5+ days

Question 22

Trmnt for spon bac peritonitis?

Answer 22

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