Ascites Flashcards
What is ascites?
Accumulation of excess fluid in the peritoneal cavity.
What is the serum-ascites albumin gradient?
Serum {Alb} - Ascitic {Alb} gradient as indicator of causes of ascites.
> 11g/L = portal hypertension related
What are the non-portal hypertension related causes of ascites? (i.e. alb gradient
- Peritoneal carcinomatosis
- TB
- Pancreatic disease
- Serositis
- Nephrotic syndrome
What is the key factor in ascites pathogenesis?
Increased sodium and water retention by kidney (not fully understood why). Peripheral arterial vasodilation theory is most popular.
What is the peripheral arterial vasodilation theory?
As portal HTN develops in cirrhosis, local mediators (e.g. NO) precipitate splanchnic arterial vasodilation –> reduced effective arterial volume –> compensatory sodium and fluid retention by kidneys. I.e. circulation relatively increased but relatively underfilled.
When is ascites clinically detectable? (volume)
> 500mL
How is ascites diagnosed?
Abdo U/S
Physical exam
Ix in ascites?
Diagnostic paracentesis:
- Cells and differential
- Chemistry (alb, total protein, amylase)
- C&S, Gram stain
- Cytology (usually positive in peritoneal carcinomatosis)
Treatment of non-refractory ascites?
-Na+ restriction (daily intake
Treatment of refractory ascites?
- Therapeutic/palliative paracentesis
- IV albumin (not if
Mortality of cirrhotic patients with ascites?
-50% 2 year mortality
Complications of ascites?
Primary / Spontaneous Bacterial peritonitis.
Proportion of asymptomatic SBP cases?
1/3 pts asymptomatic with SBP
-do not hesistate to do diagnostic paracentesis in ascites even w/o indication of infection
Signs/symptoms of SBP?
F/C/R, abdo pain, ileus, hypotension, worsening encephalopathy, AKI.
Frequent SBP pathogens?
G-ves compose 70% of pathogens: Streptococcus, Klebsiella.
