Ascites Flashcards

1
Q

What is ascites?

A

Accumulation of fluid in the abdominal cavity

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2
Q

What is the pathology of ascites?

A
  • ↑ Na and water
  • 75% due to portal hypertension
  • Underfilling: Removal of fluid in the splanchnic vascular bed due to portal hypertention → ↓ blood volume → activating RAAS and Na and H20 retention
  • Overflow: Inappropriate activation of RAAS
  • Peripheral arterial vasodilation: portal hypertension = vasodilation = ↓ arterial blood volume. Na is retailed and plasma volume expands
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3
Q

What are the risk factors/aetiology of ascites?

A
  • Cirrhosis
  • Malignancy
  • Infection – esp. TB
  • ↓ albumin
  • Congestive cardiac failure
  • Pericarditis
  • Pancreatitis
  • Myxoedema
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4
Q

What are the signs and symptoms of ascites?

A
  • Shifting dullness on abdominal examination
  • Fluid thrills – for large ascites
  • Abdominal distension
  • Pain in abdomen
  • Nausea
  • Appetite suppression
  • Dyspnoea – due to pressure
  • Hernia – pushed out due to pressure
  • Signs of liver disease if cause
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5
Q

What diseases present similarly to ascites?

A

• Other causes of abdominal mass

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6
Q

What investigations are conducted when ascites are investigated?

A
•	Measurement of abdominal girth/weight
•	FBC 
•	Renal function tests
•	LFTs - increased albumin
•	Clotting screen
•	TFTs
Aspiration microscopy
Amylase - rule out pancreatitis 
•	Abdominal ultrasound
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7
Q

What are the surgical treatments for ascites?

A
  • Paracentesis – needle inserted into the peritoneal cavity to obtain ascites fluid
  • Transjugular intrahepatic portosystemic shunt (TIPS)
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8
Q

What are the pharmacological treatments for ascites?

A
  • Diuretics – spironolactone is 1st line

* Palliative care

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9
Q

What are the non pharmacological treatments for ascites?

A

• Restricted salt intake

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