Ascites

Question 1

What are the most common causes of ascites

Answer 1

Cirrhosis - 75% (due to portal hypertension, RAAS activation (NA and water retnetion) and splanchnic vasodilatation)
Malignancy - 10%
CCF - 3%
TB - 2%
Pancreatitis - 1%

Question 2

Differential diagnosis of ascites associated with lymphadenopathy

Why would a patient with haematological malignancy develop asictes

Infectious causes of ascites

Other

Answer 2

Maligancy
TB

Haematological maligancy - can cause extra hepatic portal thrombus and ascites

Infectious - nodes can affect lymphatic duct drainage

• CMV
• HIV
• EBV
• toxoplasmosis
• Bartonella (cat scrath - ususally immunocompromised)

SLE
Sarcoidosis

Question 3

How do you detect ascites clinically

Answer 3

Fluid thrill - need large volume

Shifting dullness

• Abscence of flank dullness is most accurate predeictor of ascites
• 1500ml fluid needed to find shifting dullness

Question 4

Causes of ascites with a raised JVP

Answer 4

CCF
Atrial myxoma
Constrictive pericarditis

Question 5

in the SA-AG what is

1. ) Exudative
2. ) Transudative

Answer 5

1. ) SA-AG <11

2. ) SA-AG >11

Question 6

How do you treat ascites reltaed to cirrhosis

Answer 6

Sodium restriction
Fluid restriction
Spironolactone +/- furosemide