Ascites

Question 1

How can ascites be classified

Answer 1

serum-ascites albumin gradient (SAAG) <11 g/L or >11g/L

Question 2

Causes of high serum-ascites albumin gradient (>11)

Answer 2

Indicates portal hypertension

Liver disorders
- cirrhosis/alcoholic liver disease
- acute liver failure
- liver metastases

Cardiac
- right heart failure
- constrictive pericarditis

Other causes
- Budd-Chiari syndrome
- portal vein thrombosis
- myxoedema

Question 3

Causes of low serum-ascites albumin gradient (<11)

Answer 3

Hypoalbuminaemia
- nephrotic syndrome
- severe malnutrition

Malignancy
- peritoneal carcinomatosis

Infections
- TB peritonitis

Other causes
- pancreatitis
- bowel obstruction
- postoperative lymphatic leak
- serositis in connective tissue diseases

Question 4

Management of ascites

Answer 4

• reduce dietary sodium
• fluid restriction if Na < 125
• aldosterone antagonists
• add loop diuretics
• drainage if tense ascites
• prophylactic abx until ascites resolved
• consider TIPS

Question 5

How can paracentesis-induced circulatory dysfunction be avoided?

Answer 5

large volume paracentesis (>5L) requires albumin cover