Ascites (hepatic)

Question 1

How many liters of fluid can be detected in a physical exam?

Answer 1

greater than 1.5

Question 2

Grade 1

Answer 2

small accumulation, no symptoms. use US to diagnose

Question 3

Grade 2

Answer 3

1000 ml fluid at least, weight gain, increase girth

Question 4

Grade 3

Answer 4

No pain; pressure and SOB

Question 5

Infectious

Answer 5

abdominal pain plus fever

Question 6

Hepatic causes of ascites

Answer 6

portal HTN
chronic hepatitis
alcoholic hepatitis
vein obstruction

Question 7

Hybrid theory for pathophysiology

Answer 7

injury to liver from exogenous factors
genetic
inflammation, necrosis, collagen deposition
liver turns from low resistance to high

Question 8

Portal HTN for pathophysiology

Answer 8

backflow of dilation substances
ANG-aldosterone activated leading to fluid retention
excess volume leaks out to peritoneal area

Question 9

Signs of ascites

Answer 9

shifting dullness with percusion and fluid wave
tautness of wall and umbilicus flattens
peripheral edema (sometimes)

Question 10

Diagnostics used

Answer 10

paracentesis (needle)
labs for liver screen
imaging

Question 11

Treatment if cirrhosis is cause

Answer 11

treat liver 
stop meds that worsen 
sodium restriction 
diuretics 
remove with needle if large

Question 12

Treatment for refractory cases (tried low Na and diuretics)

Answer 12

remove with needle

liver transplant

Question 13

Infection treatment

Answer 13

IV of cephalosporin

Question 14

PT considerations

Answer 14

semi fowler
peripheral edema
muscle wasting
med complications