Portal Hypertension Ascites Flashcards
What does liver cirrhosis lead to
Portal hypertension
Liver failure
Hepatocellular carcinoma
What can portal hypertension lead to
Variceal haemorrhage
Ascites
What can ascites lead to
Spontaneous bacterial peritonitis
Hepato renal syndrome
What can liver failure lead to
Encephalopathy
Jaundice
What is ascites
Fluid within the peritoneal cavity
What symptoms can ascites lead to
Pain and discomfort
Breathlessness
Weight gain
What are the causes of ascites
Malignancy Portal hypertension Heart failure Nephrotic syndrome Infection e.g tb
What is the mechanism of ascites
- Vasodilation and reduced effective circulation volume
- RAS activation and salt retention
- portal hypertension and hydrostatic pressure
- increased capilaary permeability
- more lymph formation than return
- hyperdynamic circulation
What are the 2 types of ascites
Transudative
Exudative
How do we determine whether a patient has transudative or exudative ascites
By measuring SAAG
SAAG= serum albumin- ascitic fluid albumin
If the gradient of SAAG is high what does this suggest
Ascites due to portal hypertension
If the gradient in SAAG is low what does this suggest
Ascites it due to secondary secretory causes such as infection, cancer, inflammation e.g pancreatitis
What is the management of ascites by
Salt restritction
Diuretics
Drain (paracentesis)
What are the types of diuretics
Thiazide diuretics that work at the proximal tubule
Loop diuretics: frusemide
Aldosterone competitors e.g spirnolactone that work at the distal tubule
Vasopressin receptor antagonist that work at the collecting tubule
What is a complication of ascites
Spontanous bacterial peritontitis
