Ascites Flashcards
What is ascites?
Accumulation of fluid in the peritoneal cavity leading to abdominal swelling
What is the peritoneal cavity?
The space between the parietal peritoneum and visceral peritoneum
The two membranes that separate the organs in the abdominal cavity from the abdominal wall.
What 2 types of fluids can cause ascites?
Transudate: fluid with low protein content
Exudate: fluid with high protein count
What is the most common cause of ascites?
Cirrhosis of the liver
What are the causes of ascites?
Cirrhosis Malignancy Nephrotic syndrome Heart failure Pancreatitis
What is refractory ascites?
Ascites which can’t be shifted
Keeps recurring despite medical therapy
How does cirrhosis cause ascites?
Cirrhosis causes portal vein hypertension
As well as hypoalbuminaemia - low albumin due to liver dysfunction
Fluid leaves blood and enters peritoneal cavity
What are the clinical features of ascites?
Distended abdomen
Progressive abdominal heaviness + breathlessness
Visible bulging of the flanks when lying down
Shifting dullness: difference in percussion note in the flanks that shifts when the patient is turned on the side
A fluid thrill or wave: tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen
Pleural effusion
Peripheral oedema
Investigations for ascites.
Abdominal examination
Aspiration should be taken and analysed
What tests should you do on the ascetic fluid aspiration?
Albumin concentration: is it transudate or exudate
Neutrophil count: raised levels could indicate bacterial peritonitis
Gram stain: look for bacteria
Cytology: look for malignant cells
Amylase: to see if it’s pancreatic
What complications can arise from ascites?
Spontaneous bacterial peritonitis (SBP): infection of peritoneal cavity + fluid
What is the most common micro-organism to cause SBP?
E. coli
How do you treat SBP?
Antibiotics chosen from the culture results
Management of ascites?
Treat underlying cause
Diet: salt restriction
Diuretics
Aspiration
When you see a patient with abdominal distention, what 5 things should you consider?
5 Fs
Fat Fluid Faeces Flatus Foetus
