Background Info, Ascites Flashcards
cirrhosis complications
ascites portal HTN variceal bleeding spontaneous bacterial peritonitis (SBP hepatic encephalopathy (HE) hepatorenal syndrome (HRS)
what is the child pugh score used for bili alb ascites enceph PTT
dose adjustment for hepatic function
in order of 1pt --> 2pts --> 3pts bili: 1-2 , 2-3 , >3 Alb: >3.5 , 2.8-3.5 , <2.8 ascites: none, mild, mod enceph: none , 1 or 2 , 3 or 4 PTT : 1-4 , 4-6 , >6
A = <7 B = 7-9 C = >9
what is MELD?
Mayo ESLD
used for cirrhosis dx ands severity
used for transplant considerations
ascites
PE
Dx
PE: full, tense, bulging abdomen
Dx: abd ultrasound (shows fluid but not the cause)
abdominal paracentesis to drain peritoneum fluid and sample it–> SAAG (serum ascites albumin gradient) < 1.1 –> portal HTN from ascites is present
hesitate with paracentesis to dx ascites and portal HTN when ______________
dec plts, inc INR, dec CFs due to bleed risk
what does a paracentesis give us
SAAG
organisms/bacteria present (SBP)?
ascites treatment
sodium restrict to 2g/d
spironolactone 100mg plus furosemide 40mg (keep this ratio!!!!) can go up to 400mg:160mg
ascitic patient receives spironolactone 100mg and furosemide 40mg and their systolic blood pressure is still <90mmHg. What is the patient experiencing?
what shoulf we give the patient
diuretic refractory ascites
add Midodrine 7.5mg po TID
ascitic patient receives spironolactone 100mg and furosemide 40mg and their systolic blood pressure is still <90mmHg. Added Midodrine 7.5mg po TID.
Still refractory ascites and BP.
What should be done?
Large Volume Paracentesis (LVP) where a needle is inserted into the abdomen to drain 4-8L q2weeks
when performing a large volume paracentesis, _______ should be given to the patient if ________
give 8g IV albumin 25% if pulling off >5L
LVP AE
dec BP, inc SCr
If a patient has ascites and failed spirono + lasix, midodrine, LVP and IV albumin what is the next option?
TIPS (trans jugular intrahepatic portosystemic shunt)
connects the PV to the inferior vena cava to bypass hepatic circulation and relieve portal HTN, variceal bleeding and ascites
TIPS procedure AE
hepatic encephalopathy because we are bypassing the liver and aren’t detoxifying ammonia from the blood
TIPS is used for
refractory ascites
refractory variceal bleeding
why dont we fluid restrict in ascites
need to maintain intravascular volume since it is all in the peritoneum
