Ascites Flashcards
What can it cause
Discomfort, difficulty breathing, fatigue, nausea, poor apetitie
Treatment first line
Diuretics, dietary sodium restriction
Refractory ascites treatment
large-volume paracentesis, albumin infusion and insertion of a transjugular intrahepatic portosystemic shunt.
What is ascites
fluid accumulation in the peritoneal cavity as a result of splanchnic vasodilation and sodium and water retentio
What is hepatic hydrothorax
Large pleura effusion - from fluid passing through defect in diaphragma into pleural space
Complications of ascites
SBP
Hyponatremia
Hepatorenal syndrome
Features of decompensated liver disease
ascites, encephalopathy and gastrointestinal haemorrhage
What is SBP defined by
Ascitic fuid tap with neutrophils .250cells/mm3
Treatment of SBP
Early administration of appropriate empirical antibiotics - aware of local resistance
Albumin - esp if renal dysfunction
When give prophylaxis in ascites
Protein concentration<15g/L
Investigations for SBP
FBC
serum creatinine
ascitic fluid appearance
ascitic fluid absolute neutrophil count (ANC)
SAAG - serum ascites albumin gradient
Lactate dehydrogenase
What SAAG indicates portal HOTN as a cause of ascites
> 11g/L
Causes of ascites when SAAG >11
Cirrhosis/alcholic liver disease
Acute liver failures Liver metasteases
Cardiac - RHF, constricitve pericarditis
Other -
Budd chiari syndrome, portal vein thrombosis, veno-occlusive disease
Myxoaedma
Ascites causes when SAAG <11
Hypoalbuminaemia - nephrotic syndrome, severe malnutirtion - kwashiorkor
Malignancy - peritoneal carcinomatosiss
Infection - tuberculous pertiontitis
Other - pancreatitis, bowel obstruction, biliary, postop lymph leak, serositis in CTD
When is fluid restrictio recommended in ascites
<125 mmol/L Na
What diuretics used in ascites
Aldosterone antagonist eg spirinolactone
Loop diuretics often added
Complucations of therapeutic paracentesis
Circulatory dysfunction if large colume (>5L) eg ascites recurrence, hepatorenal syndrome, dilutional hyponatermia, moraltiy
What antibitoic prophylactic offer in ascites when protein <15
Oral cirprofloxacin or norfloxaxin until ascites reolved
What reduces risk in large volume paracentesis
Albumin cover - give albumin
When is liver trnasplation considered wtih ascites
Grade 2 or 3 ascites
First episode of ascites treatment
aldosterone antagonist (i.e., spironolactone 100 mg/day) from
the start of therapy and increased in a stepwise manner every
7 days up to 400 mg/day in the unlikely case of no respons
Should people stay on diuretics once ascites resolved
No
Which patients needto be monitored on diuretics for ascites
Renal impairment
Hyponatremia
Distubances in serum potassu,
CI for diuretics
Severe hyponatremia - <120mmol/L), progressive renal failure, worsening hepatic encephalopathy, or
incapacitating muscle cramps
What potassium levels should fursoemide vs aldosterone antagonists be stopped at
Furosemide - ,2mmol/L hypo
Aldosterone antagonist - >6 - hyper
