Ascitis

Question 1

Mc comp of cirrhosis

Answer 1

Ascitis (Poor prognosis)

Question 2

Ascitis grading (imp)

Answer 2

A)Grade I
Only detectable by USS
B)Grade II Moderate symmetrical enlargement
shifting dullness
C)Grade III Marked abdominal enlargement – transmitted thrill

Question 3

diagnostic paracentesis INDICATIONS

Answer 3

1)with new onset grade 2 or 3 ascites,
2) all patients hospitalized for worsening of ascites
3) any complication of cirrhosis

Question 4

SAAG(IMP)

Answer 4

> 1.1 indicates portal hypertension

Question 5

Total PTN with portal HTN related ascitis

Answer 5

.
● < 2.5 g/dL: cirrhotic ascites.
● ≥ 2.5 g/dL: cardiac ascites (congestive heart failure, )
or Budd-Chiari $

Question 6

Total PTN with non portal HTN related Ascitis

Answer 6

● < 2.5 g/dL: nephrotic ascites.
● ≥ 2.5 g/dL: peritoneal carcinomatosis, tuberculous Ascitis

Question 7

TTT of Ascitis

Answer 7

Salt restrictions
diuritics( in G2,3)
Large volume paracentesis( in G 3)

Question 8

Fluid restriction

Answer 8

only indicated in
hypervolemic patients with serum Na
less than 125 mmol.

Question 9

Salt restriction

Answer 9

intake of
sodium of 80–120 mmol/day, This is generally
equivalent to a no added salt diet with avoidance of
pre-prepared meals.

Question 10

Diuritics of choice
2)dose

Answer 10

Aldosterone antagonists(spironolactone)
2)100-400 increasing stepwise
every 3 days (in 100 mg steps)

Question 11

When to add fursomide
2)dose

Answer 11

1)no response(<2kg/w)

2)40-160(increasing stepwise 40 mg steps).

Question 12

Discontinuation
1)general
2)fursamide
3)spironolactone

Answer 12

1) severe hyponatremia (<120 mmol/L),
progressive renal failure, , or
incapacitating muscle cramps.
2) severe hypokalemia (<3 mmol/L).
3)severe hyperkalemia(>6)

Question 13

LVP means (TTT of choice with grade 3)

Answer 13

Drain 5 litres of ascitic fluid at
one session
REQIURE DIURITICS TTT AFTER WHICH

Question 14

PPCD(post-paracentesis circulatory dysfunction)
PREVENTION

Answer 14

administration of albumin, (6-8 g/L)

Question 15

REFRACTORY ASCITIS
1 (median survival )
2 CAUSES

Answer 15

6M
2) SBP, HRS, severe hyponatremia,pvt and HCC

Question 16

DIAGNOSIS OF REFRACTORY ASCITIS

Answer 16

weight loss of <0.8 kg over 4 day

intensive diuretic therapy (spironolactone 400 mg/day and furosemide 160 for at least 1 week)

salt-restricted diet of less than 90 mmol/day

Reappearance of grade 2 or 3 ascites within 4 weeks of initial mobilization
Diuritics induced complications

Question 17

Maximum weight loss during diuretic therapy

Answer 17

No edema 0.5 kg/day
1 kg/day in patients with edema.

Question 18

Refractory ascitis TTT

Answer 18

i. LVP plus albumin
ii. Diuretics: not effective,
iii. Liver transplantation
iv. TIPSS:

Question 19

MC cause of SBP

Answer 19

E COLI
if positive pneumococcus. And enterococcus

Question 20

SBP neutrophilic count

Answer 20

> 250

Question 21

SBP TTT

Answer 21

1ST line first line third-gen cephalosporins.

Alternative Amoxicillin/clavulanic acid
and quinolones such as ciprofloxacin.(30% resistant to quinolones)

Question 22

SBP RF

Answer 22

acute GIT hemorrhage
(2) low total PTN in ascitic fluid
and no prior history of SBP
(3) history oF SBP

Question 23

Most IMP RF OF HRS

Answer 23

SBP

Question 24

HRS TTT

Answer 24

ALBUMIN
VC(TERLIPRESSIN EHE BEST)
Liver trans(choice in grade 1,2)
Renal replacement

Question 25

HE TTT

Answer 25

Lactulose
Rifaximin
Embolization of shunt

Question 26

Mushroom poisoning

Answer 26

LEAD TO ACUTE LIVER FAiLURE

(Amanita phalloides) Phallotoxins lead to enterocyte injury and gastroenteritis.

Question 27

ALF diagnosis

Answer 27

(INR > 1.5) and
without preexisting cirrhosis and a duration. <26w