Ascites

Question 1

What i the pathophysiology behind ascites

Answer 1

Increased portal htn increases hepatic resistance, increased portal pressure, vasodilation of splanchnic arteries, increase in portal venous inflow. The hemodynamic changes result in an increase in Na retention by activation of RAAS and hyperaldosteronism. Retained fluid leaks out into peritoneal cavity. Reduction in albumin and oncotic pressure increases the problem.

Question 2

What is the most common cause of ascites

Answer 2

Portal htn

Question 3

Symptoms of ascites

Answer 3

Increased abdominal girth, SOB, hepatothorax, malnourished, fatigue, weakness, muscle wasting

Question 4

Diagnostics for ascites

Answer 4

Physical exam, abdominal fluid shift
CXR: hepatothorax

Question 5

Diagnostics for ascites

Answer 5

Physical exam
ABD imaging
CXR: hepatothorax

Question 6

Treatment for minimal, moderate, and severe ascites

Answer 6

Minimal: Na restriction
Moderate: Aldactone or lasix
Severe: Refractory to other treatments, will need repeat paracentesis, possible TIPS procedure