ascites Flashcards
definition
- abnormal accumulation of fluid within the peritoneal cavity
- associated with liver disease - cirrhosis
- can also be caused by conditions affecting heart, kidneys or peritoneum
epidemiology
common complication of cirrhosis
aetiology - pathology
- portal hypertension causes increased hydrostatic pressure
- this leads to transudation of fluid into peritoneal cavity
causes:
- liver disorders
- cardiac causes
- budd chiari
- portal vein thrombosis
other types can form due to reduced oncotic pressure, malinancy and infection
Signs and Symptoms
Abdominal distension
Abdominal discomfort or pain
Dyspnea
Reduced mobility
Anorexia and early satiety due to pressure on the stomach
Tense abdomen
Shifting dullness
Stigmata of the underlying cause (see below)
Investigations
- ascitic tap - analyse content of the fluid
- SAAG - determine cause
- bloods - underlying cause
- imaging CT abdomen
serum ascites albumin gradient (SAAG)
Calculation: serum albumin concentration – ascites albumin concentration
causes and number of raised SAAG
causes:
- cirrhosis
- heart failure
- budd chiari
- constrictive pericarditis
- hepatic failure
> 1.1g/L
- raised portal pressure
- water into peritoneal cavity but albumin stays in vessels
causes of low SAAG
- Cancer of the peritoneum, metastatic disease
- Tuberculosis, peritonitis and other infections
- Pancreatitis
- Hypoalbuminaemia - nephrotic syndrome, Kwashiokor
management
- addressing underlying cause
- high SAAG - selt restricted diet
- 1st line spironolactone - aldosterone antagonist
- 2nd line furosemide - loop diuretic
- therapeutic paracentesis + human albumin solution
If the ascitic tap shows neutrophils >250mm3
- spontaneous bacterial peritonitis
- serious complication of ascites
- treated with IV piperacillin-tazobacam
- prophylactic - ciprofloxacin
- human albumin solution
when should TIPS be considered
refractory ascites
absolute contradition to preforming paracentesis
disseminated intravascular coagulation
- bleeding gums
- raised D dimer
- low fibrinogen
most common cause of elevated SAAG
liver cirrhosis
