Ascites

Question 1

Ascites?

Answer 1

Accumulation of fluid in the abdominal/peritoneal cavity

Question 2

What is ascites an example of?

Answer 2

Third spacing

Question 3

Third spacing?

Answer 3

It is when fluid gets into spaces where it is not readily exchanged

Question 4

Etiology of Ascites?

Answer 4

• Cirrhosis & portal HTN
• Right-sided heart failure
• Severe changes in CHP or OP

Question 5

How does right-sided heart failure result in ascites?

Answer 5

Right sided heart failure causes congestion within the right side of the heart and a back up of blood into the systemic circuit. Increased blood volume in the vessels within the abdominal organs -> increased CHP -> fluid shift into the interstitial space of the abdominal organs -> abdominal organ distention -> fluid shift into the abdominal cavity -> ascites

Question 6

How do severe changes in CHP or OP result in ascites?

Answer 6

A disruption of either CHP, affected changes in blood volume, or OP, affected by concentration of plasma proteins in the blood, will result in a fluid shift. Increased CHP within the vessels or decreased OP results in ascites

Question 7

Does the following need to be increased or decreased to result in ascites?

1. CHP
2. OP

Answer 7

1. Increased

2. Decreased

Question 8

What are some factors that contribute to a decrease in OP?

Answer 8

• Proteinurea (loss of protein in urine)
• fluid volume excess ( dilution of protein concentration in the blood)
• liver failure (decreased synthesis of plasma protein)

Question 9

Manifestations of Ascites?

Answer 9

• dyspnea

- abdominal distention

Question 10

Why does dyspnea occur in ascites?

Answer 10

Accumulation of fluid increases the pressure within the abdominal cavity, which impedes movement of the diaphragm to increase the volume of the thoracic cavity to expand the lungs.

Question 11

Why does abdominal distention occur in ascites?

Answer 11

Because there is increased fluid in the abdominal cavity.

Question 12

Abdominal distention. Where will the fluid be in the following?:

1. A patient is lying flat. Small volume
2. A patient is lying flat. Large volume
3. Pt stands up

Answer 12

1. The fluid will move to the sides of their abdomen
2. Fluid will remain centrally with a uniform
3. Fluid will flow downwards with gravity

Question 13

What are the treatment options for ascites?

Answer 13

• Small volume (5L or less): diuretics and sodium restriction
• fluid and electrolytes to correct imbalances caused by fluid shift
• Large volume (5L or more): Paracentesis + plasma volume expander

Question 14

Why are diuretics used?

Answer 14

Diuretics are used to increase fluid loss to decrease blood volume

Question 15

Why might a patient be put on sodium restriction?

Answer 15

To decrease blood volume

Question 16

Why is a plasma volume expander used along side paracentesis?

Answer 16

If the fluid shift is continually occurring then the paracentesis will essentially just drain the fluid out of the vasculature. So Albumin (plasma volume expander) is administered to increase the OP within the blood vessels. The increase in OP in the blood counters the increase CHP in the blood [which is what is causing the fluid shift]

(decreasing push pressure by opposing it by increasing pull pressure will stop fluid from moving from the intravascular space and into the abdominal cavity)