Ascites

Question 1

What is ascites?

Answer 1

Accumulation of fluid within the peritoneal cavity

Question 2

What is the clinical presentation of ascites?

Answer 2

Abdominal distension
Abdominal pain
Dyspnoea
Reduced mobility
Anorexia and early satiety
Tense abdomen
Shifting dullness

Question 3

What is the primary investigation for ascites?

Answer 3

Ascitic tap

Question 4

What other investigations are useful in ascites?

Answer 4

SAAG - serum ascites albumin gradient
FBC, U&Es, LFTs, CRP
Imaging - CT abdomen, CXR

Question 5

What are the causes of a high SAAG?

Answer 5

SAAG >11g/dL :
- Cirrhosis
- Budd Chiari syndrome
- Constrictive pericarditis
- Hepatic failure

Question 6

What does a high SAAG suggest?

Answer 6

Ascites is due to raised portal pressure

Question 7

What are the causes of a low SAAG?

Answer 7

Cancer of the peritoneum
Metastatic disease
TB
Peritonitis
Pancreatitis
Hypoalbuminaemia

Question 8

What is the first line management of ascites?

Answer 8

Spironolactone

Question 9

What is recommended in the treatment of ascites with a high SAAG?

Answer 9

Fluid restriction, and a low sodium diet

Question 10

What is the management of ascites refractory to medical management?

Answer 10

Regular therapeutic paracentesis

Question 11

What is the most serious complication of ascites?

Answer 11

Spontaneous bacterial peritonitis

Question 12

What is the diagnostic criteria for SBP?

Answer 12

Ascitic tap with neutrophils >250

Question 13

What is the prophylactic treatment of SBP?

Answer 13

1st line - ciprofloxacin

Question 14

What is the indication for prophylaxis of SBP?

Answer 14

Ascites due to cirrhosis, and ascites protein <15g/L
Previous SBP
Hepatorenal syndrome