Ascites

Question 1

What is ascites?

Answer 1

Accumulation of serious fluid in the peritoneal or abdominal cavity

Question 2

2 cause for ascites

Answer 2

Hypoalbuminemia
Liver is unable to synthesis albumin
This decreased albumin result in ⬇️ colloidal oncotic pressure
* means that the body isn’t able to draw back anything from 3rd spacing because it is low on albumin*

Question 3

3 cause for ascites

Answer 3

Hyper aldosterone
- Aldosterone is not metabolized by damaged liver cells. 
⬆️ level of Aldosterone causes:
⬆️ sodium  ⬆️ water  ⬆️ ADH
- edema         - water retention 
- ⬇️ GFR     - ⬇️ renal blood flow

Question 4

1 cause of ascites

Answer 4

Portal HTN shifts proteins from blood vessels to lymphatic space. Lymphatic system cannot carry off excess protein & water so it leaks into peritoneal cavity.
Oncotic pressure associated with proteins pulls fluid into cavity.

Question 5

Pharmacological management Ascites

Answer 5

• Spironolactone ( k+ sparring)
• Lasix (furosemide)
• Albumin
• Albumin 50% because it has a ⬆️ osmotic pull

Question 6

Ascites management

Answer 6

• Bed rest : produces dieresis
• Colloids: Hypertonic solution (3% NaCl, D10W, D5 in LR…)
• Paracentesis ( will be done when patient respiratory is compromised)
• daily weights
• weight loss no more than 1g or 2.2 lb
• fluid restrictions 500- 1000 ml/day