Ascities Flashcards
- Q: What is ascites?
A: Abnormal accumulation of fluid within the peritoneal cavity.
- Q: What is the most common cause of ascites?
A: Cirrhosis, accounting for approximately 85% of cases.
- Q: Name two causes of portal hypertension leading to ascites.
A: Cirrhosis and Budd-Chiari syndrome.
- Q: Name one malignancy commonly associated with ascites.
A: Peritoneal carcinomatosis.
- Q: How does hypoalbuminemia contribute to ascites?
A: By reducing intravascular colloid osmotic pressure.
- Q: What happens when hydrostatic pressure increases in portal veins?
A: Fluid transudation from the gastrointestinal tract and peritoneum occurs.
Q: What role does nitric oxide play in ascites?
A: It causes splanchnic arterial vasodilation and renal hypoperfusion.
Q: How does malignancy cause ascites?
A: Through lymphatic blockage and increased vascular permeability.
Q: Name two symptoms of ascites.
A: Progressive abdominal distension and early satiety.
Q: What is shifting dullness?
A: A change from dull to tympanic resonance when a patient changes position.
Q: What is the fluid wave test?
A: A wave transmitted across the abdomen when tapped, indicating ascitic fluid.
Q: What is the initial study of choice for ascites diagnosis?
A: Abdominal ultrasound.
Q: What laboratory test is essential in evaluating ascitic fluid?
A: Serum-ascites albumin gradient (SAAG).
Q: What does a SAAG value ≥ 1.1 g/dL suggest?
A: Portal hypertension-related ascites.
Q: Name one indication for diagnostic paracentesis.
A: New-onset ascites.
Q: What does a cloudy appearance of ascitic fluid suggest?
A: Infection or malignancy.
- Q: What is chylous ascites?
A: Triglyceride-rich lymph fluid in the abdominal cavity.
Q: What is hemorrhagic ascites?
A: Ascitic fluid with RBC count > 50,000/mm³.
Q: Name one cause of pancreatic ascites.
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A: Acute pancreatitis
Q: What is the primary approach to managing ascites?
A: Treating the underlying condition.
Q: When is therapeutic paracentesis indicated?
A: For tense or large ascites.
Name a diuretic commonly used for ascites management.
A: Spironolactone.
What is the daily sodium restriction for ascites patients?
A: 2 g/day.
When is fluid restriction recommended?
A: When serum sodium is < 125 mEq/L.
What is hepatorenal syndrome?
A: Acute, reversible renal failure in cirrhotic patients with ascites.
Name one trigger for hepatorenal syndrome.
A: Refractory ascites.
What is the first-line treatment for hepatorenal syndrome?
A: Vasopressin (e.g., terlipressin) and albumin.
Q: What is SBP?
A: Infection of ascitic fluid without a focal intraabdominal source.
- Q: Which bacteria commonly cause SBP?
A: Escherichia coli and Klebsiella spp
Name two symptoms of SBP.
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A: Abdominal pain and fever
What neutrophil count in ascitic fluid indicates SBP?
A: ≥ 250/mm³.
What is the treatment for SBP?
A: Broad-spectrum IV antibiotics, such as cefotaxime.
Why should NSAIDs be avoided in cirrhotic ascites?
A: They worsen renal perfusion.
What is the role of albumin in therapeutic paracentesis?
A: Prevents postparacentesis circulatory dysfunction.
- Q: What invasive procedure can be considered for refractory ascites?
A: Transjugular intrahepatic portosystemic shunt (TIPS).
What does a milky ascitic fluid indicate?
A: Chylous ascites.
What does a dark brown ascitic fluid suggest?
A: Biliary leak.
What protein concentration in ascitic fluid suggests cirrhosis?
A: < 2.5 g/dL.
Name a cause of ascites due to hypoalbuminemia.
A: Nephrotic syndrome.
What type of malignancy often causes peritoneal carcinomatosis?
.
A: Ovarian carcinoma
What is a common infectious cause of ascites?
A: Tuberculosis.
Q: What is the role of serial abdominal examinations in SBP?
A: To monitor treatment response.
What is a key indicator of poor antibiotic response in SBP?
A: Less than 25% reduction in ascitic PMNs after 48 hours.
What is the difference between transudate and exudate in ascitic fluid?
A: Transudate is associated with portal hypertension (SAAG ≥ 1.1 g/dL), while exudate is due to other causes (SAAG < 1.1 g/dL).
Name two conditions that cause high protein levels (> 2.5 g/dL) in ascitic fluid.
A: Tuberculosis and peritoneal carcinomatosis.
Name a condition that causes low protein levels (< 2.5 g/dL) in ascitic fluid.
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A: Cirrhosis
What color of ascitic fluid suggests a traumatic or malignant etiology?
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A: Bloody
What is the definition of refractory ascites?
A: Ascites that does not respond to treatment or recurs after therapeutic paracentesis.
What dietary recommendation is essential in refractory ascites management?
A: Strict sodium restriction.
Name one invasive treatment option for refractory ascites.
A: Liver transplantation.
What is the median survival for patients with refractory ascites?
.
A: About one year
What percentage of patients with advanced cirrhosis develop hepatorenal syndrome?
A: Approximately 10%.
Name a common complication of large-volume paracentesis.
A: Postparacentesis circulatory dysfunction (PPCD).
What is the most common bacterial infection in cirrhotic patients with ascites?
A: Spontaneous bacterial peritonitis (SBP).
What is the most common route of bacterial translocation in SBP?
A: Through the intestinal wall to the mesenteric lymph nodes.
Name one laboratory test critical for diagnosing SBP.
A: Ascitic fluid cell count and differential.
Why are ascitic fluid cultures often negative in SBP?
A: Due to the fastidious nature of the bacteria or low bacterial load
What adjunctive therapy improves outcomes in SBP?
A: IV albumin supplementation.
Name two risk factors that indicate the need for IV albumin in SBP patients.
A: Blood urea nitrogen > 30 mg/dL and total bilirubin > 5 mg/dL.
What is the role of TIPS in ascites management?
A: It reduces portal hypertension and improves ascitic fluid control.
