Ascites Flashcards
What is ascites?
Ascites is the abnormal accumulation of fluid in the abdomen.
What are the two groups of causes for ascites based on SAAG levels?
The causes of ascites can be grouped into those with a SAAG > 11 g/L (indicates portal hypertension) and SAAG < 11 g/L.
What are the common causes of ascites with SAAG > 11 g/L?
Common causes include liver disorders such as cirrhosis, alcoholic liver disease, acute liver failure, and liver metastases.
What cardiac conditions can cause ascites?
Right heart failure and constrictive pericarditis can cause ascites.
What are some other causes of ascites with SAAG > 11 g/L?
Other causes include Budd-Chiari syndrome, portal vein thrombosis, veno-occlusive disease, myxoedema.
What conditions can lead to ascites with SAAG < 11 g/L?
Conditions include hypoalbuminaemia, nephrotic syndrome, severe malnutrition (e.g. Kwashiorkor), malignancy (peritoneal carcinomatosis), and infections (tuberculous peritonitis).
What are some other causes of ascites?
Other causes include pancreatitis, bowel obstruction, biliary ascites, postoperative lymphatic leak, and serositis in connective tissue diseases.
What are the management strategies for ascites?
Management includes reducing dietary sodium, fluid restriction, aldosterone antagonists (e.g. spironolactone), and loop diuretics.
What is the recommendation for large-volume paracentesis?
Large-volume paracentesis requires albumin ‘cover’ to reduce paracentesis-induced circulatory dysfunction and mortality.
What complications can arise from large volume paracentesis?
Complications include ascites recurrence, development of hepatorenal syndrome, dilutional hyponatraemia, and high mortality rate.
What is recommended for prophylaxis against spontaneous bacterial peritonitis?
Prophylactic antibiotics such as oral ciprofloxacin or norfloxacin are recommended for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less.
What is a potential treatment option for some patients with ascites?
A transjugular intrahepatic portosystemic shunt (TIPS) may be considered in some patients.
