ASCITES Flashcards
Ascites
Accumulation of excess fluid within the peritoneal
cavity.
Causes of ascites
Portal hypertension secondary to liver cirrhosis
Renal failure
Nephrotic syndrome
Cardiac failure
Abdominal tuberculosis
Intra-abdominal or pelvic malignancies
Symptoms of ascites include
Abdominal enlargement
Abdominal discomfort or pain
Difficulty breathing
Signs of ascites
Distended abdomen
Shifting dullness
Fluid thrill
Abdominal tenderness
Signs relating to the underlying causes
Investigations in ascites
FBC
BUE & Creatinine
LFTs
INR
Urinalysis
Abdomino-pelvic ultrasound
Chest X-ray
Diagnostic paracentesis
Components of a diagnostic paracentesis
Appearance and colour
Gram stain
Cell count and differential
Biochemistry e.g. Albumin
Microscopy, culture
Acid fast bacilli
Cytology
Treatment objectives in ascites
To relieve symptoms
To identify and manage underlying cause
Non-pharmacological treatment of hepatic encephalopathy
Bed rest
Salt restriction <2 g/day
Fluid restriction to ≤1.5 L/day
Avoid NSAID-use
Alcohol abstinence
Therapeutic paracentesis (sterile abdominal tap)
When is therapeutic paracentesis done
If ascites is tense and/or there is respiratory embarrassment
Up to……. of ascitic fluid can be removed as a safe short term option in ascites without infusion of colloids
5L
Pharmacological treatment to control ascitic fluid accumulation
Spironolactone
Adults
50-200 mg daily
Children
0.3-3 mg/kg daily
And
Furosemide, oral,
Adults
20-80 mg daily
Children
1-2 mg/kg daily
Treatment of massive ascites in liver cirrhosis with respiratory embarrassment
requiring more than 5 litres of fluid drainage
Salt-poor human albumin solution, IV, 6-8 g per litre of ascitic fluid drained
Referral criteria in ascites
Poor response to diuretic therapy or diuretic-refractory ascites
Complicated cirrhotic ascites with suspected spontaneous bacterial peritonitis
Hepato-renal syndrome
Hepatic encephalopathy
Underlying cause cannot be identified
