Ascites

Question 1

Ascites

Answer 1

Acities is the abnormal accumulation fluid in the abdominal (peritoneal) cavity

Question 2

Ascites Aetiology: Portal Hypertension

Answer 2

*SAAG >1.1 g/dl is Ascites which is caused by Portal Hypertension: CCC BMM: Cirrhosis, Congestive Heart Failure, Constrictive Pericarditis, Budd Chiari, Myxedema, Massive liver metastases.

Question 3

Ascites Aetiology: caused by other reasons

Answer 3

*SAAG <1.1g/dl is Ascites caused by other reasons: MTB CNS: eg. Malignancy, TB, Biliary Ascites, Chylous Ascites, Nephrotic Syndrome, Serositis.

Question 4

Ascites Symptoms

Answer 4

Breathlessness
Bloating
Abdominal Pain

Question 5

Ascites Signs

Answer 5

Dullness in flanks and shifting dullness
Flank Haematoma
Abdominal Veins
Fetor Hepaticus
Spider Naevi
Umbilical Nodule
Palmar Erythema
JVP elevated.

Question 6

Ascites Investigations:

Answer 6

Ultrasound (Main investigation)
Paracentesis (Diagnostic) (aspirate ascitic fluid for cytology, culture and protein level)
Cell Count
Albumin concentration
SAAG (>1.1g/dl is high, <1.1g/dl is low)

Question 7

Ascites Treatment:

Answer 7

Diuretics (spironolactone)
Large volume paracentesis (when doing this, give albumin to patient to reduce paracentesis-induced circulatory dysfunction)
Liver Transplantation
Acquaretics
TIPS (maybe considered in some patients)

Patients with ascites should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis.