Ascites Flashcards
what is ascites?
fluid collection in the peritoneal cavity
what is third-spacing?
when fluid moves from the intravascular space into the interstital or “third” space
third space = nonfunctional area between cells
what disease is ascites a common cx of?
cirrhosis
what is the most common etiology for ascites?
cirrhosis
besides cirrhosis, what else can cause ascites?
chronic alcohol use, IV drug use, obesity, T2DM, hypercholesterelmia
what is the patho of ascites via portal HTN pathway?
- Portal pressure > critical threshold
- increased nitric oxide released by endothelial cells 3. vasodilation → decreased blood flow to kidneys
- kidneys retain water and sodium
- increased hydrostatic pressure (pressure of blood against the wall) in splanchnic vessels (vessels for the GI tract)
- net fluid flux out of the vasculature (high pressure/concentration) into the interstitial space (low pressure/concentration)
what is the patho of ascites via hepatic insufficiency pathway?
- less albumin production
- decreased capilliary oncotic pressure in the vasculature
- net fluid flux out of the vasculature into the interstitial space to balance it out
s/s of ascites
- abdo distention ➔ painless w/ abdo discomfort
- wt gain
- early satiety
- SOB and dyspnea
- positive shifting dullness and fluid wave
s/s of spontaneous bacterial peritonitis
ascites s/s
unlocalized generalized pain - abdo tender
confusion
fevers/
s/s of malignant ascites and def
constitutional s/s - fever, wt loss, night sweats
production of proteinaceous fluid by tumour cells in the peritoneum
how can you ix ascites?
- test the ascitic fluid ➔ blood cell count, bacterial culture, ascites-albumin gradient
- imaging ➔ chest xray (elevated diaphragm), U/S ➔ check morison’s pouch. CT ➔ look for collection and any masses
tx of ascites
- treat underlying cause
- volume control: diet restriction (low sodium), diuretics
- could consider therapeutic paracentesis and albumin supplements or surgical shunting
