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10- SA- Abdominal, Oral and Rectal Disease > Ascites > Flashcards

Ascites Flashcards

1
Q

List the clinical signs of Ascites

A

dependent on underlying cause
abdominal distension
some discomfort
dyspnoea- from pressure on abdomen
lethargy
O can report weight gain, difficulty getting up and down

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2
Q

List the differentials for abdominal distension

A

Organomegaly (splenomegaly, hepatomegaly)
Abdominal mass
Pregnancy
Bladder distension
Obesity
Gastric distension
All above have abdominal distension without effusion

Ascites

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3
Q

describe how we identify ascites

A

History – both past and recent
Clinical examination – look at the whole animal!
Ballottement
Ultrasound- see free fluid

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4
Q

What do you do if you see free fluid on ultrasound

A

sample it

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5
Q

what does a septic abdominal fluid look like grossly

A

opaque and foul smelling

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6
Q

describe what a protein-poor transudate looks like

A

Clear, colourless or pale straw colour

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7
Q

describe what a protein-rich transudate looks like

A

Often yellow, blood tinged, turbid

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8
Q

what is the TP, TNCC and cytology of protein-poor transudate

A

TP<20
<1.5
Neutrophils and macrophages with some mesothelial cells

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9
Q

what is the TP, TNCC and cytology of protein-rich transudate

A

TP=usually >20
TNCC= <5
Macrophages and mesothelial cells, increasing number of neutrophils and small lymphocytes

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10
Q

describe the appearance of exudate

A

Typically turbid, various colours

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11
Q

what is the TP, TNCC and cytology of exudate

A

TP >20
TNCC > 5
Neutrophils, or neutrophils and macrophages

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12
Q

describe the pathophysiology of protein-poor transudate

A

altered fluid dynamics
hypalbuminaemia
decrease in plasma colloid oncotic pressure

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13
Q

List the differentials that can cause protein-poor transudate ascites

A

Protein-losing nephropathy
Hepatic failure- not making enough albumin
protein-losing enteropathy

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14
Q

describe the pathophysiology of a protein-rich transudate

A

increased hydraulic pressure within blood
Protein leaks from permeable capillaries, ascites develops when resorptive capacity of regional lymphatics is overwhelmed.
TP important characteristic - over time, transudates will irritate the mesothelium, leading to inflammation, and increased TNCC

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15
Q

What investigations do we do to work out cause of protein-poor transudate

A

Biochemistry - Key
- liver parameters
kidney- nephropathy

urinalysis , ultrasound

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16
Q

List 4 differentials that c an cause protein-rich transudate

A

Cardiovascular disease
Chronic liver disease – post-hepatic portal hypertension
Neoplasia
Thrombosis- RARE

17
Q

What investigations do we do to work out cause of protein-rich transudate

A

Start with imaging:
- Ultrasound
- radiography (thoracic)
biochemistry

18
Q

describe the pathophysiology of formation of exudate

A

inflammatory process causing- – chemotactants and vasoactive substances attract inflammatory cells, and cause increased vascular permeability

19
Q

List 4 differentials that can cause exudate (septic)

A

Penetrating wound
Surgical complication
Rupture of infected lesion
Bacteraemia (rare)

20
Q

What investigations do we do to work out cause of exudate (septic)

A

abdominocentesis
appearance/ smell of fluid
cytology
culture and sensitivity - though will need to do something whilst we wait
lactate, glucose

21
Q

List 4 differentials that can cause exudate (non-septic)

A

Neoplasia
Uroperitoneum
Bile peritonitis
FIP

All poor prognosis

22
Q

What investigations do we do to work out cause exudate (non-septic)

A

Abdominocenetesis
appearance of fluid
cytology
fluid analysis
biochem
ultrasound

23
Q

describe the fluid analysis if uroperitoneum present

A

high urea, creatinine and potassium in fluid

24
Q

describe the fluid analysis if bile peritonitis

A

green-gold material in fluid

25
Q

Describe the pathophysiology of lymphatic compromise

A

Obstruction or destruction of lymphatics—> Leakage of lymph and lipids

chylous

26
Q

List the differentials that can cause chylous

A

Cardiac disease
Hepatic disease
Neoplasia
Steatitis

27
Q

what is steatitis

A

inflammation of fat

28
Q

List the investigations to find cause of chylous effusion

A

appearance- looks milky
cytology
fluid analysis
ultrasound
biochemistry

29
Q

List 3 differential causes of haemorrhagic effusion

A

Surgical and non-surgical trauma
Haemostatic defects
Neoplasia

30
Q

List the investigations to perform to find cause of haemorrhagic effusion

A

PCV & TP of fluid
Presence of platelets
Cytology
Ultrasound

10- SA- Abdominal, Oral and Rectal Disease (19 decks)

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