Ascites

Question 1

What is ascites?

How much fluid is normal for men and women?

Answer 1

Accumulation of excess fluid in the peritoneum cavity
Healthy male: no fluid.
Women: up to 20mL normal.

Question 2

What is the most common cause of ascites causing 75% of cases?

Answer 2

Most common: cirrhosis.

Second most common: malignancy

Question 3

What is the clinical presentation of ascites?

Answer 3

Can vary depending on aetiology but in general:

• Abdominal distention
• Abdominal pain or discomfort
• Cachexia
• Constipation
• Nausea, loss of appetite

Question 4

Signs of ascites?

Answer 4

• Jaundice and other stigmata if caused by liver disease
• Puddle sign
• Abdominal distention (1.5-2L)
• Full flanks (>1500mL)
• Shifting dullness (>500mL)
• Umbilical hernia in 20% cirrhotic patients with ascites

Question 5

What investigations can we carry out for ascites?

Answer 5

Determining underlying cause - LFTs, cardiac function
Imaging - Xray, CT, USS
Ascitic aspiration (under imaging guidance)
Fluid for microscopy, culture, cytology (including mycobacterium, protein content and amylase content)

Question 6

Treatment of ascites?

Answer 6

• Treat underlying cause (eg. portal venous pressure raised then treat with transjugular, intrahepatic, portosystemic shunt.
  Sodium restriction (200mg per day)
  Diuretics (spironolactone and furosemide combination)
  Paracentesis with colloid replacement or albumin replacement to avoid re-occurence
  Indwelling drainage for drainage of smaller amounts of fluid at home
  Perineovenous shunting - for rapidly accumulating ascites