Ascites Flashcards
decreased _____ can lead to ascites
Oncotic pressure
What can lead to a fluid shift from intra to extra vascular?
Low albumin
When the kidneys sense hypoperfusion, what is increased? 2
- Renin
- Aldosterone
To prevent ascites, what needs to be managed?
Portal hypertension
What nutrition requirements would help prevent ascites?
- Maintain protein intake
- Mild salt restriction
What is the weight loss goal through diuresis?
0.5 kg daily
What is the Spironolactone: Furosemide ratio?
100:40
What is the target dose for Spironolactone in ascites?
400 mg
What is the target dose for furosemide in ascites?
160 mg
Spironolactone can cause ____kalemia
Hyper
Furosemide can cause _____kalemia
Hypo
What drug should you consider for refractory ascites?
Midodrine
What needs replaced in refractory ascites?
Albumin
What surgery can a patient receive for refractory ascites?
Trans jugular intrahepatic portosystemic shunt (TIPS)
What is the MOA of midodrine?
Alpha 1 agonist
What does midodrine help maintain for the diuretics to be increased?
Blood pressure
What are 4 ADRs for midodrine?
- Urinary retention
- Itching
- Hypertension
- Paresthesia
Drainage of the fluid is called
Paracentesis
What can lead to hepatorenal syndrome?
Hypotension
What needs to be utilized to avoid a ascitic leak?
Z track technique
What are 3 complications of paracentesis?
- Bleeding
- Ascitic fluid leak
- Infection
When is albumin replacement recommended?
When >5 L of fluid is removed
What preparation of albumin is used?
25%
What is the dose for albumin replacement?
8g/L
Renal failure due to hypoperfusion of the kidneys
Hepatorenal syndrome
What 2 drug classes MUST be avoided in hepatorenal failure?
- NSAIDs
- Aminoglycosides
What type of hepatorenal failure?: slow progressive renal failure
Type 2
What type of hepatorenal failure?: acute renal failure
Type 1
What type of hepatorenal failure?: May respond to therapy and improve to baseline renal function
Type 1
What type of hepatorenal failure?: no effective treatment can stop progression
Type 2
What type of hepatorenal failure?: Has better prognosis
Type 1
What are 3 symptoms of spontaneous bacterial peritonitis?
- Fever
- Abdominal pain
- Mental status changes
What is the translocation of intestinal bacteria into the peritoneum due to?
Decreased bowel motility, increased bacterial growth, increased intestinal permeability
What is the main thing needed for primary prophylaxis of bacterial peritonitis?
Low ascitic fluid protein (<1.5 g/L)
What 4 additional things are needed for primary prophylaxis in spontaneous bacterial peritonitis?
- Impaired renal function (SCr >1.2)
- BUN >25
- Sodium <130 mEq
- Liver failure (Child’s Pugh >9 and bilirubin >3 mg/dL)
What patients need secondary prophylaxis for spontaneous bacterial peritonitis?
ALL patients with SPB diagnosis and liver disease
What are 2 prophylactic agents needed for SBP?
- Ciprofloxacin
- Bactrim (quinolone intolerance)
What is the PMN count that is needed for diagnosis of SBP?
> 250 mm3
What needs to be assessed for SBP?
If community or hospital-acquired
What is the criteria for monitoring if the bacteria community or hospital acquired?
- > 48 hours in the hospital on current admission or within 3 months
- Recent utilization of IV antibiotics (90 days)
If the SBP is community acquired what is used for treatment?
- Cefotaxime
- Ceftriaxone
(Use quinolones if allergy)
If the bacteria is nosocomial what is used to treat?
- Zosyn
- Cefipime
- Carbapenems
(If MRSA positive add vancomycin)
How long are IV antibiotic used?
5 days
If HVPG is reduced by ___% or more ascites improves or is prevented
10
