Ascites

Question 1

Define ascites.

Answer 1

Pathological accumulation of fluid within the peritoneal cavity.

Question 2

Who does is affect?

Answer 2

· 3/4 of cases are associated with portal hypertension secondary to cirrhosis.

· 50-60% of cirrhotic patients will develop ascites within 10 years.

Question 3

What is the difference between transudate and exudate?

Answer 3

· Transudate - due to increased pressure in the hepatic portal vein (e.g. due to cirrhosis).

· Exudate - actively secreted fluid due to inflammation or malignancy.

Question 4

What are the 2 main pathways for ascites in the context of cirrhosis?

Answer 4

1. Portal hypertension.

2. Sodium and water retention.

Question 5

What are the risk factors for ascites?

Answer 5

· Alcohol.
· Low protein diet.
· Hepatitis.
· Cirrhosis.
· Cardiac disease.

Question 6

What are the common signs and symptoms that accompany ascites?

Answer 6

· Flank dullness requires 1.5L of ascitic fluid to be detected.
· Shifting dullness.
· Pain.
· SOB.
· Abdominal distension.
Other symptoms are based on cause.

Question 7

What 3 investigations can be done to help diagnose ascites?

Answer 7

1. Bloods.
2. Imaging - USS.
3. Diagnostic aspiration - paracentesis.

Question 8

List some differential diagnoses.

Answer 8

· Hepatitis C.
· Alcoholic hepatitis.
· Congestive heart failure.
· Nephrotic syndrome.
· Pancreatitis.

Question 9

What treatment options are available?

Answer 9

· Identify and treat cause.
· Diuretics.
· Paracentesis.

Question 10

List some complications that may occur.

Answer 10

· Spontaneous bacterial peritonitis· 
· Haemoperitoneum. 
· Refractory ascites. 
· Hepatic encephalopathy.
· Hepatorenal syndrome.