Ascites

Question 1

Ascites

Answer 1

Pathological accumulation of fluid within peritoneal cavity.
Most commonly associated with cirrhosis and severe liver disease.

Question 2

Classifying ascites

Answer 2

By serum-ascites albumin gradient (SAAG)
Either < 11g/L or > 11g/L

Question 3

Causes of SAAG > 11g/L

Answer 3

Liver disorders:
- cirrhosis/alcoholic liver disease
- acute liver failure
- liver metastases

Cardiac:
- right heart failure
- constrictive pericarditis

Other:
- Budd-Chiari syndrome
- portal vein thrombosis
- veno-occlusive disease
- myxoedema

Question 3

Serum-ascites albumin gradient (SAAG) > 11g/L

Answer 3

Indicates portal hypertension

Question 4

Causes of SAAG < 11g/L

Answer 4

Hypoalbuminaemia:
- nephrotic syndrome
- severe malnutrition

Malignancy:
- peritoneal carcinomatosis

Infections:
- tiberculous peritonitis
- spontatneous bacterial peritonitis

Other:
- pancreatitis
- bowel obstruction
- biliary ascites

Question 5

Managing ascites

Answer 5

1. Reduce dietary sodium
2. Aldosterone antagonists (spironolactone)(+/- loop diuretic)
3. Abdominal paracentesis (drainage)