Ascites Flashcards
List the clinical signs of Ascites
dependent on underlying cause
abdominal distension
some discomfort
dyspnoea- from pressure on abdomen
lethargy
O can report weight gain, difficulty getting up and down
List the differentials for abdominal distension
Organomegaly (splenomegaly, hepatomegaly)
Abdominal mass
Pregnancy
Bladder distension
Obesity
Gastric distension
All above have abdominal distension without effusion
Ascites
describe how we identify ascites
History – both past and recent
Clinical examination – look at the whole animal!
Ballottement
Ultrasound- see free fluid
What do you do if you see free fluid on ultrasound
sample it
what does a septic abdominal fluid look like grossly
opaque and foul smelling
describe what a protein-poor transudate looks like
Clear, colourless or pale straw colour
describe what a protein-rich transudate looks like
Often yellow, blood tinged, turbid
what is the TP, TNCC and cytology of protein-poor transudate
TP<20
<1.5
Neutrophils and macrophages with some mesothelial cells
what is the TP, TNCC and cytology of protein-rich transudate
TP=usually >20
TNCC= <5
Macrophages and mesothelial cells, increasing number of neutrophils and small lymphocytes
describe the appearance of exudate
Typically turbid, various colours
what is the TP, TNCC and cytology of exudate
TP >20
TNCC > 5
Neutrophils, or neutrophils and macrophages
describe the pathophysiology of protein-poor transudate
altered fluid dynamics
hypalbuminaemia
decrease in plasma colloid oncotic pressure
List the differentials that can cause protein-poor transudate ascites
Protein-losing nephropathy
Hepatic failure- not making enough albumin
protein-losing enteropathy
describe the pathophysiology of a protein-rich transudate
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
What investigations do we do to work out cause of protein-poor transudate
Biochemistry - Key
- liver parameters
kidney- nephropathy
urinalysis , ultrasound
List 4 differentials that c an cause protein-rich transudate
Cardiovascular disease
Chronic liver disease – post-hepatic portal hypertension
Neoplasia
Thrombosis- RARE
What investigations do we do to work out cause of protein-rich transudate
Start with imaging:
- Ultrasound
- radiography (thoracic)
biochemistry
describe the pathophysiology of formation of exudate
inflammatory process causing- – chemotactants and vasoactive substances attract inflammatory cells, and cause increased vascular permeability
List 4 differentials that can cause exudate (septic)
Penetrating wound
Surgical complication
Rupture of infected lesion
Bacteraemia (rare)
What investigations do we do to work out cause of exudate (septic)
abdominocentesis
appearance/ smell of fluid
cytology
culture and sensitivity - though will need to do something whilst we wait
lactate, glucose
List 4 differentials that can cause exudate (non-septic)
Neoplasia
Uroperitoneum
Bile peritonitis
FIP
All poor prognosis
What investigations do we do to work out cause exudate (non-septic)
Abdominocenetesis
appearance of fluid
cytology
fluid analysis
biochem
ultrasound
describe the fluid analysis if uroperitoneum present
high urea, creatinine and potassium in fluid
describe the fluid analysis if bile peritonitis
green-gold material in fluid
