ascites my G

Question 1

What are causes of ascites?

Answer 1

• Cirrhosis
• malignancy
• RHF
• nephrotic syndrome
• protein losing enteropathy
• portal vein thrombosis
• TB
• pancreatitis

Question 2

2 different types of ascites. GO!

Answer 2

• transudate = due to failure/low protein state and is mainly fluid (no protein)
• exudate = fluid + protein - inflammatory, infective or malignant

Question 3

Investigating an ascites are we? How do?

Answer 3

• abdo girth and weight for progression
• bloods - all the usual
• imaging - USS or MRI - fibroscan for cirrhosis (then look for cause of cirrhosis)
• ascitic tap - MC&S + cytology

Question 4

classify ascites.

Answer 4

1-4
1- only found on careful inspection 
2- obvious but small volume 
3- large volume but not yet tense 
4- very large volume and tense

Question 5

How do you treat ascities?

Answer 5

• treat underlying cause
• fluid restriction + maybe low sodium target
• therapeutic ascitic tap if large + tense
• spironolactone - increased fluid loss
• shunts - TIPS
• prophylactic abx (ciprofloxacin) in cirrhosis + ascites or 1 ep of SBP

Question 6

important test when ?HCC?

Answer 6

-alfa-fetoprotein

Question 7

What surveillance for HCC is there? Who gets it?

Answer 7

• USS +/- Alfa fetoprotein
• anyone with cirrhosis secondary to hepatitis B/C or haemochromatosis
• men with cirrhosis 2nd to alcohol

Question 8

Tx for HCC?

Answer 8

• early stage surgical resection
• radiofrequency ablation
• trans-arterial chemo embolization
• liver transplant
• sorafenib - multikinase inhibitor