Ascites Flashcards
The portal vein drains all the blood from the GI tract through the liver. Which of the following is NOT a tributary of the portal vein?
1 - splenic vein
2 - inferior mesenteric vein
3 - coeliac vein
4 - superior mesenteric vein
3 - coeliac vein
- portal venous system also contains toxins that can be excreted by the kidneys
Once the blood moves from the portal venous system through its tributaries into the liver, it is processed. What vessels does this then leave the liver by?
1 - inferior vena cava
2 - superior vena cava
3 - coeliac vein
4 - superior mesenteric vein
1 - inferior vena cava
- travels up IVC to right atrium and into the systemic circulation
There are 3 locations where the portal venous system can be connected with the systemic venous system which collects blood from the rest of the body. Which of the following is NOT one of these?
1 - superior portion of the anal canal
2 - inferior portion of the esophagus
3 - renal veins
4 - round ligament (umbilical vein)
3 - renal veins
- these are important because if patient has portal hypertension or liver cirrhosis, these are the places disease may present
At birth the umbilical cord is cut causing the umbilical vein to collapse. It then becomes what?
1 - round ligament
2 - falciform ligament
3 - coronary ligament
4 - right triangular ligament
1 - round ligament
- remains closed normally as portal venous system and systemic venous system are the same = 5-10mmHg
Organs in the body, including the cavities in the body contain a serous membrane. This serous membrane contains a lining of mesothelial cells that lubricate these organs and cavities and reduce friction. What are the 2 layers of this called?
1 - visceral layer
2 - endothelial layer
3 - parietal layer
4 - epithelial layer
1 - visceral layer
3 - parietal layer
- fluid is contained between these layers
Is the accumulation of fluid in the parietal space between the visceral and parietal layers of the serosa always pathological?
- yes
Examples of fluid accumulations in parietal space before fluid can be detected:
- Ascites 500ml
- Pleural effusions 300ml
- Pericardial effusion 50ml
What are ascites?
1 - accumulation of fluid in the pericardium
2 - accumulation of fluid in the testicles
3 - accumulation of fluid in the kidneys
4 - accumulation of fluid in the peritoneum cavity
4 - accumulation of fluid in the peritoneum cavity
- diagnosis of ascites is generally when there is >1500ml
- ascites = greek for bag of sac
Are ascites always pathological?
- yes
This is the formula for calculating filtration/reabsorption rate:
Qf = Peff x Kf
- Qf = filtration/reabsorption rate
- Peff = effective filtration pressure, which is the difference between hydrostatic and oncotic pressure
- Kf = filtration coefficient, which is the permeability and surface area of biological membranes to water
Based on the above, which of the following is important when considering the filtration re-absorption rate?
1 - hydrostatic pressure
2 - oncotic pressure
3 - membrane permeability
4 - membrane surface area
5 - all of the above
5 - all of the above
Which of the following is NOT likely to cause effusions?
1 - decreased hydrostatic pressure
2 - decreased oncotic pressure
3 - increased membrane permeability
4 - modulated surface area exchange
1 - decreased hydrostatic pressure
- an increase would cause effusions as the increased pressure forces fluid from blood vessels
Which of the following is NOT a cause of portal hypertension that increases hydrostatic pressure, forcing fluid out of blood vessels and can lead to ascites?
1 - liver cirrhosis
2 - alcoholic hepatitis
3 - chronic cardiac failure
4 - constrictive pericarditis
5 - nephrotic syndrome
6 - large PE
5 - nephrotic syndrome
- can cause hepatorenal failure in rare cases
Which of the following is NOT a cause of hypoalbuminemia that reduces oncotic pressure, leading to fluid leaking out of blood vessels and can lead to ascites?
1 - liver cirrhosis
2 - nephrotic syndrome
3 - protein losing enteropathy
4 - malnutrition
1 - liver cirrhosis
Which of the following is NOT a cause of peritoneal disease
that affects the perfusion and surface area of membranes, leading to fluid leaking out of blood vessels and can lead to ascites?
1 - malignancy/carcinomatosis
2 - Iinfections (TB, fungal)
3 - nephrotic syndrome
4 - vasculitis
5 - peritonitis
6 - lymphoproliferative malignancies
3 - nephrotic syndrome
Ascites is the accumulation of excessive fluid in the peritoneal space, generally >1500ml. This can be further subdivided into 3 categories. What is grade 1 ascites?
1 - moderate ascites causing moderate symmetrical distension of the abdomen
2 - mild ascites and is only detectable by ultrasound examination
3 - large ascites causing marked abdominal distension
4 - low fluid that is undetectable
2 - mild ascites and is only detectable by ultrasound examination
- ultrasound is able to detect <500ml of fluid
Ascites is the accumulation of excessive fluid in the peritoneal space, generally >1500ml. This can be further subdivided into 3 categories. What is grade 2 ascites?
1 - moderate ascites causing moderate symmetrical distension of the abdomen
2 - mild ascites and is only detectable by ultrasound examination
3 - large ascites causing marked abdominal distension
4 - low fluid that is undetectable
1 - moderate ascites causing moderate symmetrical distension of the abdomen
Ascites is the accumulation of excessive fluid in the peritoneal space, generally >1500ml. This can be further subdivided into 3 categories. What is grade 3 ascites?
1 - moderate ascites causing moderate symmetrical distension of the abdomen
2 - mild ascites and is only detectable by ultrasound examination
3 - large ascites causing marked abdominal distension
4 - low fluid that is undetectable
3 - large ascites causing marked abdominal distension
Ascites can be subdivided into uncomplicated and refractory ascites. Which of these is easier to treat?
- uncomplicated ascites
- refractory ascites is hard to treat and has increased mortality
Ascites can be subdivided into uncomplicated and refractory ascites. Which of these is more common?
- uncomplicated ascites
All of the following are causes of ascites, but which is the most common?
1 - alcoholic hepatitis
2 - liver cirrhosis
3 - viral hepatitis
4 - malignancy
5 - heart failure
2 - liver cirrhosis
- accounts for 80% of ascites
- closely followed by viral and alcoholic hepatitis
A problem with the portal venous systems ability to drain into the liver, generally due to a cirrhotic liver can lead to a build up of blood in the portal venous system, causing portal hypertension. What pressure is diagnostic of portal hypertension?
1 - >120mmHg
2 - >70mmHg
3 - >30-50mmHg
4 - >5-10mmHg
4 - >5-10mmHg
Features of portal hypertension:
- A = Ascites
- B = Bleeding
- C = Caput medusae
- D = Diminished liver function
- E = Enlarged spleen.
If a patient develops portal hypertension (>5-10mmHg) this can cause portosystemic shunts. If the toxins in the blood are not filter in the liver, what can this lead to?
1 - liver failure
2 - liver hepatitis
3 - hepatic encephalopathy
3 - hepatic encephalopathy
- toxins in the blood like ammonia can pass blood brain barrier
If a patient develops portal hypertension (>5-10mmHg) this can cause portosystemic shunts. The 3 main places this occurs are superior portion of the anal canal, inferior portion of the esophagus and then round ligament (umbilical vein). What can portosystemic cause in the inferior portion of the esophagus?
1 - barretts esophagus
2 - achalasia
3 - metaplasia
4 - varices
4 - varices
- essentially enlarged esophageal veins
- very fragile and can cause extensive upper GI bleed
- portal hypertension is the most common cause
- treated with endoscopic banding and beta blockers or if these fail, then TIPSS (Trans intrahepatic portosystemic shunt) or surgery (venous shunts)
If a patient develops portal hypertension (>5-10mmHg) this can cause portosystemic shunts. The 3 main places this occurs are superior portion of the anal canal, inferior portion of the esophagus and then round ligament (umbilical vein). What can portosystemic cause in the superior portion of the anal canal?
1 - fistula formation
2 - pilonidal sinus
3 - haemorrhoids
4 - diverticulitis
3 - haemorrhoids
- enlarged veins that can bleed
If a patient develops portal hypertension (>5-10mmHg) this can cause portosystemic shunts. The 3 main places this occurs are superior portion of the anal canal, inferior portion of the esophagus and then round ligament (umbilical vein). What can portosystemic cause in the round ligament (umbilical vein?
1 - striae (stretch marks)
2 - caput medusae
3 - cullen’s sign (blood around umbilicus)
4 - grey-Turner’s sign (bruising in the flanks)
2 - caput medusae
- round ligament becomes patent due to pressure changes
- blood flows into abdominal veins that are visible on abdomen
- cullen’s sign (blood around umbilicus) and grey-Turner’s sign (bruising in the flanks) are both signs of pancreatitis
If a patient develops portal hypertension (>5-10mmHg) this can cause portosystemic shunts. This can cause blood to back up into the spleen, causing splenomegaly, leading to trapped blood contents in the spleen. Which of the following is NOT caused by splenomegaly?
1 - anaemia
2 - hyponatraemia
3 - leukopenia
4 - thrombocytopenia
2 - hyponatraemia