ASCITES

Question 1

What is used to group the causes of ascites

Answer 1

serum-ascites albumin gradient (SAAG)

Question 2

What are causes of ascites if SAAG>11g

Answer 2

This indicates portal hypertension
Liver disorders -most common
– cirrhosis/alcoholic liver disease
–acute liver failure
–liver metastases

Cardiac
–right heart failure
-constrictive pericarditis

Other causes-
Budd-Chiari syndrome - obstruction of hepatic venous outflow
Portal vein thrombosis
veno-occlusive disease
myxoedema

Question 3

What are causes of ascites if SAAG<11g

Answer 3

Hypoalbuminaemia
-nephrotic syndrome
-severe malnutrition

Malignancy
-peritoneal carcinomatosis infections
- tuberculosis peritonitis

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

Question 4

What are key diagnostic factors

Answer 4

abdominal distension
fluid detected on physical examination with shifting dullness
rapid weight gain
swelling in ankles
back pain
fatigue
digestive issues

Question 5

What is the 1st investigation to order

Answer 5

Abdominal ultrasound

Question 6

What other investigations can be ordered

Answer 6

CT
MRI

Question 7

What is management of ascites

Answer 7

Reducing dietary sodium
fluid restriction of sodium <125mmol/L

aldosterone antagonists

Drainage if tense ascites ( therapeutic abdominal paracentesis )
–requires IV albumin cover to avoid paracentesis induced circulatory dysfunction

Prophylactic oral ciprofloxacin or norfloxacin to reduce risk of spontaneous bacterial peritonitis

Consider transjugular intrahepatic portosystemic shunt

Question 8

What are risk factors for ascites

Answer 8

non -alcoholic associated fatty liver disease

hepatitis B
Hepatitis C

alcohol use disorder

autoimmune hepatitis