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Medicine Phase 2a GI > Ascites > Flashcards

Flashcards in Ascites Deck (26)
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1
Q

Define

A

Accumulation of free fluid within the peritoneal cavity

2
Q

% survival within 5 years of onset

A

10-20%

poor prognosis

3
Q

Ascites is common from what

A

Post-operation

Complication of cirrhosis

4
Q

*Main causes

A
Local inflammation
Low protein (inability to pull fluid back into intravascular space by osmosis)
Low flow (fluid can't move forwards through system e.g. due to a clot)
5
Q

When would local inflammation cause ascites

A

Peritonitis
Intra-abdominal surgery (post)
Abdominal cancers (ovarian)
Infection (TB)

6
Q

When would you see low protein

A

Hypoalbumineamia
Nephrotic syndrome
Malnutrition

7
Q

When would you see low flow (and ascites resulting)?

A

Cirrhosis (portal hypertension)
Budd-chiari syndrome (occlusion of hepatic veins that drain liver)
Cardiac failure
Constrictive pericarditis

8
Q

Risk factors

A

High sodium diet
Hepatocellular carcinoma
Splanchnic vein thrombosis, resulting in portal hypertension

9
Q

Clinical presentation

A
  • Abdominal swelling (develop over days or wks)
  • Distended abdomen
  • Fullness in the flanks and SHIFTING DULLNESS
  • Mild abdominal pain and discomfort
  • Respiratory distress and difficulty eating
  • Scratch marks on abdomen (caused by itching due to jaundice i.e. liver failure)
  • Peripheral oedema
10
Q

Why is shifting dullness important in presentation

A

confirms the presence of fluid

11
Q

Diagnosis

A
  • Shifting dullness
  • Diagnostic aspiration of 10-20ml of fluid using Ascitic Tap
  • Protein measurement of ascitic fluid from ascitic tap (transudate or exudate)
12
Q

What would be done with (diagnostic) aspiration of fluid using ascitic tap

A

Check for Raised white cell count (bacterial peritonitis)
Gram stain and culture
Cytology and malignancy
Amylase to exclude pancreatic ascites

13
Q

Protein measurement of ascitic fluid from ascitic tap: what is meant by transudate

A

Low protein (<30g/L)

14
Q

Protein measurement of ascitic fluid from ascitic tap: causes of transudate

A
  • Portal hypertension e.g. cirrhosis
  • Constrictive pericarditis
  • Cardiac failure
  • Budd-Chiari syndrome
15
Q

Protein measurement of ascitic fluid from ascitic tap: what is meant by exudate

A

High protein (>30g/L)

16
Q

Protein measurement of ascitic fluid from ascitic tap: causes of exudate

A
  • Malignancy
  • Peritonitis
  • Pancreatitis
  • Peritoneal tuberculosis
  • Nephrotic syndrome
17
Q

Treatment

A
  • Treat underlying cause
  • Increase renal sodium excretion (or reduce sodium)
  • Drain fluid (paracentesis) - can drain 5 litres at a time, used to relieve symptomatic tense ascites
  • Transjugular Intraheptic Portosytemic Shunt (for resistant ascites, risky)
18
Q

Treatment - what diuretic should be given

A

Aldosterone antagonist e.g. oral spirolactone

since it spares K+

19
Q

Describe how ascites results from cirrhosis

A

In cirrhosis -> peripheral arterial vasodilation (controlled by NO, other vasodilators) -> reduction in effective blood volume
Activation of sympathetic nervous system and RAAS, promoting salt and fluid retention
Oedema formation is encouraged by hypoalbuminaemia and mainly localised to peritoneal cavity due to portal hypertension.

20
Q

What increased hydrostatic pressure in ascites

A

Portal hypertension

RAAS activation

21
Q

What causes oedema in ascites

A

Oncotic pressure decreases in liver cirrhosis due to hypoalbuminaemia
Hydrostatic pressure > oncotic pressure

22
Q

Ascites signs

A

Distended abdomen

Shifting dullness

23
Q

Investigations

A

Ascitic tap = culture, gram stain, cytology, protein

24
Q

Management

A

Restrict fluid and sodium
Spironolactone
Treat underlying cause

25
Q

Appearance of transudate vs Exudate

A
Transudate = clear
Exudate = Cloudy
26
Q

Albumin level in Transudate vs Exudate

A

Transudate: 11g/L or more below serum albumin
Exudate: <11g/L below the serum albumin