ascites Flashcards
what is ascites?
- abnormal accumulation of fluid within the abdominal cavity
- complication of cirrhosis
what are the types of causes of ascites?
- local inflammation
- low protein
- flow stasis- impaired blood flow
what can cause local inflammation in ascites?
- peritonitis
- TB
- Abdo cancer
what can cause low protein in ascites?
- nephrotic syndrome
- hypoalbunimia
-malnutrition
what can cause flow stasis in ascites?
- cirrhosis
- budd chiari
- constructive pericarditis
- cardiac failure
why does low protein cause ascites?
with low protein, you can’t pull fluid back to intra- vascular space therefore accumulates in peritoneum
why does flow stasis cause ascites?
fluid can’t move through the system and therefore increases pressure therefore fluids leaks out of vessels
what are the symptoms of ascites?
- abdo- distension ( risk of SBP)
- shifting dullness ( fullness in flanks and fluid thrill)
- jaundice and prutitus
describe how you do the shifting dullness test?
- tap on central abdomen when supine= resonant- bowel floats
tap on flanks= dull due to fluids - ask patient to lay on side and tap flank= resonant
—-as fluid has shifted to other side and bowel floated here
how is ascites diagnosed?
- shifting dullness on exam
- ascitic tap ( paracentesis of 10-20 ml of fluid)
what are the two types of ascitic taps?
- cytology WCC
- protein measurement
—-transudate
or
— exudate
describe the transudate ascitic tap
< 30 g/L protein ( low), SAAG is < 11g/L
- clear fluid
- fluid due increases hydrostatic pressure
describe the exudate ascitic tap
> 30g/L protein ( high), SAAG is > 11g/L ( or equal to)- serum ascites albumin gradient- assesses extent of ascites
- cloudy fluid
-fluid due to inflammation mediated exudation or low oncotic pressure
how are ascites treated?
- treat underlying cause
- diuretic- to increase sodium excretion therefore more fluid flushed out- spironolactine
- paracentesis- drain fluid
- liver transplant
