Ascites

Question 1

Assessment of Ascites

Answer 1

1. Dullness on percussion in the lower quadrants Dull = Fluid
2. Bulging flanks
3. Shifting dullness - dullness shifts to dependent side, tympany shifts to the top
4. Fluid wave

Question 2

Causes of Ascites

Answer 2

cirrhosis, 
malignancy 
heart failure
abdominal obesity
giant ovarian/mesenteric cyst
bowel obstruction

Question 3

Main issues associated with ascites

Answer 3

Is it infected

Is there portal hypertension

Question 4

Initial Ascitic fluid tests

Answer 4

Appearance
SAAG - Serum-to-Ascities Albumin Gradient
- gradient ≥1.1 g/dL (≥11 g/L) predicts portal hypertension
Cell count and differential
Total protein concentration

Question 5

Definition of SBP

Answer 5

PMV > 250/ul

Tx: 3rd generation cephalosporin, fluoroquinolone