Abdominal Distension Flashcards Preview

MD2 Ambulatory Care and Emergency Medicine > Abdominal Distension > Flashcards

Flashcards in Abdominal Distension Deck (18)
Loading flashcards...
1
Q

What are the causes of ascites?

A
Portal hypertension
- Cirrhosis
- Alcoholic hepatitis
- Cardiac failure/pericarditis
- Budd-Chiari syndrome
- Massive hepatic metastasis
Peritoneal carcinomatosis, esp ovarian
Pancreatitis
Nephrotic syndrome
Peritoneal TB
Serositis
2
Q

What are the top four causes of cirrhosis in Australia?

A
  1. Alcohol
  2. Hep C
  3. NASH
  4. Hep B
3
Q

What can be concluded about ascites from a Doppler ultrasound?

A
Confirms presence, if in doubt
May diagnose cirrhosis
May confirm portal HTN
May diagnose portal vein thrombosis
May diagnose HCC
4
Q

What can be concluded about ascites from an ascitic tap?

A

Diagnostic

Can be therapeutic

5
Q

What tests are run on ascitic taps?

A
Microscopy
Culture
Sensitivity
Ascitic
- Albumin
- Protein concentration
Rarely cytology
6
Q

What is the pathogenesis of spontaneous bacterial peritonitis?

A

Leaky membranes
Poor opsonisation
Sub-optimal immune response

7
Q

How is spontaneous bacterial peritonitis diagnosed?

A

PMN cell count >250 cells/mL from tap

Detectable growth on culture

8
Q

What are the risk factors for spontaneous bacterial peritonitis, in the presence of ascites?

A
Low ascitic protein
High serum bilirubin
Prior spontaneous bacterial peritonitis
Variceal bleeding
Malnutrition
PPI therapy
9
Q

What is the management for a patient who is at high risk of spontaneous bacterial peritonitis?

A

Prophylactic antibiotics

10
Q

What is SAAG?

A
Serum albumin-ascites gradient
= [serum albumin] - [ascitic albumin]
IDs ascites due to portal HTN
- SAAG >11 g/L = portal HTN
- SAAG <11 g/L = non-portal HTN
11
Q

What is the management of ascites?

A
Treat underlying disease if possible
Avoid NSAIDs and ACE inhibition
Na restriction
Fluid restriction
Diuretics
- Watch serum K and renal function
Therapeutic ascitic tap > only if bothering patient
12
Q

Why restrict sodium in the presence of hyponatraemia?

A

Na diluted, not actually low

13
Q

What is the aetiology of varices?

A

Portal HTN > engorgement of collaterals and porto-systemic shunting

14
Q

What is the risk of variceal haemorrhage related to?

A

Varix size
Endoscopic stigmata
Previous bleeds
Hepato-venous portal pressure gradient >12 mmHg

15
Q

What are the common causes of upper GI bleeding?

A

Peptic ulcer disease
Varices
Oesophagitis
Mallory-Weiss tear

16
Q

What is the treatment for acutely bleeding oesophageal varices?

A

Endoscopically
- Band ligation
- Injection of glue/sclerosant
- Tamponade with Sengstake-Blakemore tube
Pharmacologically
- Splanchnic vasoconstrictor = terlipressin/somatostatin analogue
Radiological decompression/occlusion of varices
Surgical decompression

17
Q

What is the primary prophylaxis of variceal bleeding?

A

Non-selective beta-blockade
- Bradycardia and hypotension often poorly tolerated in advanced cirrhosis
Endoscopic band ligation if varices large and high risk/advanced cirrhosis

18
Q

What is the secondary prophylaxis of variceal bleeding?

A

Regular endoscopic band ligation/injection to eradicate varices