Ascites Flashcards
what is it
fluid within the peritoneal cavity, causing abdominal swelling
cirrhosis is the commonest cause
precipitating factors
high sodium diet
hepatocellular carcinoma
splanchnic vein thrombosis
pathology
in cirrhosis, peripheral arterial vasodilatation (mediated by NO) –> reduction in effective blood volume, activation of sympathetic NS + renin-angiotensin system –> renal salt and water retention
what encourages the formation of oedema?
hypoalbuminaemia
non-portal hypertension causes
malignancy
cardiac failure
nephrotic syndrome
clinical features
fullness in flanks
shifting dullness
tense ascites: uncomfortable + produces resp distress
what do you need to look at in a diagnostic aspiration of fluid?
albumin: transudate/exudate neutrophil count: ?underlying SBP Gram stain and culture Cytology: malignant? Amylase: to exclude pancreatic ascites
Treatment aim
to reduce sodium intake + increase renal excretion of sodium –> net reabsorption of fluid from the ascites into the circulating volume
Pharmacological treatment
Diuretic: spironolactone (aldosterone antagonist)
salt & fluid restriction
albumin/colloid replacement
what is paracentesis
perforation of a cavity of the body/ a cyst with a hollow needle to remove fluid or gas
to relieve symptomatic tense ascites
what to do for resistant ascites
transjugular intrahepatic portosystemic shunt (TIPS)
what anasarca
generalised oedema including skin + subcut tissue
its associated with nephrotic syndrome
