ascites Flashcards
define ascites
the abnormal accumulation of fluid within the peritoneal cavity
what are the factors needed for normal tissue fluid formation?
- normal blood flow
- right amount of intravascular proteins to pull fluid back in
- intact blood vessel wall that is not leaky
what is the ascites albumin gradient?
it is used to classify ascites into transudate and exudate
it compares the amount of protein in the ascitic fluid to the amount of protein in the blood
What does it mean if there is a high ascites albumin gradient?
there is a transudate as there is a large difference in the concentration of protein in the blood vessels and in the ascitic fluid, so this means that protein is not leaking out of the blood vessels into the ascitic fluid
what does it mean if there is a low ascites albumin gradient?
there is an exudate as there is protein on both sides
What are the reasons, according to the formation of tissue fluid, that people have ascities?
impaired blood flow
inadequate proteins
leaky membranes
How is transudate formed?
outflow problem ie portal hypertension
decreased oncotic pressure
membrane is FINE
What are the three conditions that lead to a transudate-type ascites?
cirrhosis
cardiac failure
Budd-Chiari syndrome
how is ascites managed?
treat the underlying cause
diet - ie reduce salt intake
diuretics - first spironolactone, then furosemide spironolactone doesn’t work
then drainage by paracentesis and albumin
How is exudate formed?
low serum albumin or more porous membrane
What are the causes of exudate-type ascites?
cancer
sepsis
TB
nephrotic syndrome
Name a significant complication of ascites
spontaneous bacterial peritonitis
How can you tell whether sb has developed SBP?
generally unwell
they have ascites and have deteriorated
What investigation is done for SBP?
paracentesis - gram stain, neutrophil count, acid fast bacilli stain
How is SBP treated?
antibiotics + therapeutic paracentesis
