Ascities (brief)

Question 1

What causes it?

Answer 1

Fluid in the peritoneal cavity. Cirrhosis is the commonest cause. In cirrhosis, peripheral arterial vasodilation (mediated by nitric oxide and other vasodilators) leads to reduction in effective blood volume, with activation of sympathetic NS and RASS, thus promoting salt and water retention. All encouraged by hypoalbuminemia and mainly localized to the peritoneal cavity.

Question 2

How does it present?

Answer 2

Fullness in the flanks, with shifting dullness. Tense ascites is uncomfortable and produces respiratory distress. A pleural effusion (usually right sided) and peripheral oedema may be present.

Question 3

Investigations?

Answer 3

A diagnostic aspiration of 20ml of ascetic fluid should be carried out in all patients: Albumin (albumin conc >11g/L suggests a transudate, if below than an exudate, neutrophil count, gram stain and culture, cytology for malignant cells and amylase to exclude pancreatic ascites

Question 4

Treatment?

Answer 4

Depends on the cause. Diuretics: restrict sodium, oral spirolactone, frusemide is added if response is poor. Aim to lose 500g of body weight per day.
Paracentesis is used if the ascites is tense or are resistant to standard medical therapy. the perforation of a cavity of the body or of a cyst or similar outgrowth, especially with a hollow needle to remove fluid or gas.