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SA DX & TX II > Exam 3 - Ascites > Flashcards

Exam 3 - Ascites Flashcards

1
Q

T/F: ascites is a sign of disease & not a diagnosis

A

true

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2
Q

what is ascites?

A

accumulation of fluid in the peritoneal cavity causing abdominal swelling

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3
Q

what are some other causes of abdominal distension that should be ruled out when considering ascites?

A

obesity, pregnancy, GDV, distended bladder, constipation, mass

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4
Q

what is the first step in working up a patient known to have ascites?

A

need to determine what type of abdominal effusion is present - diagnostic abdominocentesis is an essential part of the work up

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5
Q

what tests should be run on abdominal effusion in a patient with ascites?

A

specific gravity, total protein, +/- BUN, creatinine, bilirubin, & cytology

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6
Q

after doing a physical exam & getting a history on a patient presenting with abdominal enlargement, what diagnostics should you pursue? why?

A

rads & ultrasound - need to differentiate between organomegaly, abdominal effusion, or the absence of a mass/fluid

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7
Q

what supplies do you need for an abdominocentesis?

A

red top - for biochemistry panel

EDTA - for cytology

culturette tubes for bacterial culture

slides for cytology

can do blind or ultrasound guided

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8
Q

what is the 4 quadrant approach for abdominocentesis?

A

patient in left lateral or dorsal recumbency

in left lateral - insert needle just caudal to the umbilicus 1 to 2 cm to the right of midline & avoid the epigastric blood vessels

in dorsal recumbency - insert needle just caudal to the umbilicus 1 to 2 cm to the left/right of midline & avoid the epigastric blood vessels

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9
Q

what are the 7 general types of effusions seen in patients with ascites?

A
  1. septic exudate
  2. transudate
  3. modified transudate
  4. bile peritonitis
  5. hemo-abdomen
  6. uro-abdomen
  7. chylo-abdomen
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10
Q

how are effusions classified?

A

based on specific gravity, protein content, & number of cells present

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11
Q

what is the main sign that you have an exudative effusion?

A

high number of cells, >5,000, mostly neutrophils, & protein >3

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12
Q

what are some examples of diseases that can cause a pure transudate?

A

hypoalbuminemia, portal hypertension (pre-sinusoidal)

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13
Q

what are some examples of diseases that can cause a modified transudate?

A

right-sided heart failure, portal hypertension, & neoplasia

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14
Q

what are some examples of diseases that can cause a septic exudate?

A

bowel perforation, foreign body, & septic bile peritonitis

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15
Q

what are some examples of diseases that can cause a non-septic exudate?

A

pancreatitis, FIP, urine, bile, & neoplasia

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16
Q

if you have a result of a transudate or modified transudate on your patient with ascites, what should you investigate?

A

check their albumin

check for right-sided heart failure

check for portal vein thrombosis/portal hypertension

check for pancreatitis (usually exudate though)

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17
Q

if you have a result of an exudative effusion on your patient with ascites, what should you investigate?

A

check for the presence of bacteria

check for pancreatitis

check for bile/urine

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18
Q

if you have a result of a hemorrhagic effusion on your patient with ascites, what should you investigate?

A

check for bleeding disorders

check for bleeding masses

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19
Q

if you have a result of a chylous effusion on your patient with ascites, what should you investigate?

A

look for neoplasia or a lymphatic blockage

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20
Q

what is the most common cause of a pure transudate effusion?

A

low oncotic pressure due to a serum albumin concentration < 1.6 g/dL

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21
Q

if you have a patient with a pure transudate effusion off of abdominocentesis, & you suspect protein losing nephropathy, what do you expect their serum globulin concentration to be? what diagnostic test would you use to confirm?

A

normal to high

urine protein to creatinine ratio > 2

22
Q

if you have a patient with a pure transudate effusion off of abdominocentesis, & you suspect hepatic insufficiency, what do you expect their serum globulin concentration to be? what diagnostic test would you use to confirm?

A

normal to high

serum bile acid testing

23
Q

if you have a patient with a pure transudate effusion off of abdominocentesis & suspect protein losing enteropathy, what do you expect their serum globulin concentration to be? what diagnostic test would you use to confirm?

A

decreased, normal, or high

rule out other causes - fecal alpha-1 proteinase inhibitor

24
Q

T/F: radiographs are very sensitive for detecting ascites

A

false

25
Q

T/F: pure transudates are rarely caused by pre-sinusoidal portal hypertension such as portal vein thrombosis or hepatic artery/vein malformation

A

true

26
Q

what is the general cause of modified transudates?

A

increased hydrostatic pressure

27
Q

what are some examples of right-sided heart diseases causing modified transudates? what diagnostics are indicated?

A

tricuspid valve disease, HWD, pericardial tamponade, restrictive pericarditis, myocardial disease, & arrhythmias

physical exam & cardiac ultrasound

28
Q

what diagnostic test should you always do on exudates?

A

culture!!!!

29
Q

what is almost always indicated in a patient with a septic exudate? what imaging should be done prior?

A

emergency exploratory surgery

abdominal rads - look for free gas

abdominal ultrasound

CT if available - especially in big dogs

30
Q

how is portal hypertension as a cause of a modified transudate diagnosed?

A

abdominal ultrasound

bile acids

+/- liver biopsy

31
Q

how is abdominal neoplasia as a cause of a modified transudate diagnosed?

A

abdominal ultrasound & surgical exploratory

32
Q

T/F: fluid cytology is rarely diagnostic for neoplasia causing a modified transudate

A

true

33
Q

what are some common causes of non-septic exudate?

A

pancreatitis

FIP in cats

uroabdomen

bile peritonitis

neoplasia

34
Q

what diagnostics are indicated for investigating a non-septic exudate?

A

abdominal imaging - ultrasound & consider CT

test effusion for bilirubin or urea/creatinine as indicated

test for pancreatitis with cPLI/fPLI as indicated

consider testing for FIP in cats

35
Q

how do you differentiate between a spontaneous & iatrogenic hemoabdomen based off of hemorrhagic effusion?

A

take a sample from abdominocentesis

leave the sample in a plain tube - if it clots, it is iatrogenic

if it doesn’t clot - spontaneous

36
Q

if you have an effusion that appears to be red but you’re unsure if it is hemorrhagic, how do you investigate it?

A

check hematocrit - transudates & exudates usually have a PCV <5%

37
Q

what are 4 examples of causes of hemoabdomen?

A

trauma

neoplasia

coagulopathy

hepatic amyloidosis in cats

38
Q

what should be included in the work up of a patient with a hemorrhagic abdominal effusion?

A

ask about a history of trauma

rule out systemic bleeding disorders - platelet count, coagulation panel, +/- BMBT

thoracic/abdominal imaging to look for masses

39
Q

what effusion is shown here?

A

chylous

40
Q

what are some common causes of chylous abdominal effusions?

A

trauma, neoplasia, infection, & right-sided heart failure

41
Q

what are the characteristics of a chylous effusions?

A

turbid, poaque, milky

SG > 1.025 & protein > 2.0 g/dL

effusion triglycerides are higher than serum levels

effusion cholesterol: triglyceride ratio <1

mostly lymphocytes

42
Q

when would you remove abdominal effusion on a patient with ascites? why?

A

reserved for patients with difficulty breathing

depletes the protein reserves & fluid often quickly reforms

43
Q

what does the efficacy of diuretics used for treating ascites depend on?

A

depends on the underlying cause of the ascites

44
Q

what is the main difference between furosemide & spironolactone?

A

furosemide - potassium wasting

spironolactone - potassium sparing

45
Q

what is included in the symptomatic treatment of ascites?

A

treat the underlying cause!!!!

removal of fluid - reserved for patients with difficulty breathing

diuretics

moderate sodium diet - useful adjunctive treatment

46
Q

T/F: septic peritonitis is an indication for emergency surgery

A

true

47
Q

what is the pathogenesis of portal hypertension?

A

hepatic fibrosis & nodular regeneration leads to hepatic (sinusoidal) portal hypertension

48
Q

what are 4 examples of patients with ascites that need emergency surgery?

A

septic peritonitis - cytology & culture

uroabdomen - measure BUN/creatinine in fluid & blood to confirm

bile peritonitis - measure bilirubin in fluid & blood

hemoabdomen with uncontrollable bleeding - reassess patient’s vital signs & PCV

49
Q

how do you evaluate a patient for a fluid wave?

A

place one hand on one side of the ventral abdomen & then ballot with your hand on the opposite side of the abdomen

50
Q

should you just bolus fluids into a shocky patient with severe abdominal bleeding?

A

nope - give whole blood or autotransfuse

51
Q

to determine the type of effusion, what 3 things do you need to determine?

A

fluid’s specific gravity/total protein

nucleated cell count

differential cell count

52
Q

if you have a patient that you suspect to have ascites, and you see a jugular pulse on your physical exam, what do you think is the underlying cause of the effusion?

A

right-sided heart disease

SA DX & TX II (62 decks)

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