Ascites: Difference between revisions
| Line 6: | Line 6: | ||
*Fluid wave | *Fluid wave | ||
*+/- [[SOB]] if massive amount | *+/- [[SOB]] if massive amount | ||
==Causes== | |||
*[[Cirrhosis]] 81%<ref>Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.</ref> | |||
*Malignancy 10% | |||
*[[Heart failure]] 3% | |||
*[[Tuberculosis]] 2% | |||
*Other 4% | |||
===Complications=== | ===Complications=== | ||
*[[SBP]] | *[[SBP]] | ||
*[[Hepatorenal syndrome]] | *[[Hepatorenal syndrome]] | ||
*[[ | *[[Pleural effusion]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 26: | Line 33: | ||
*[[FAST]] | *[[FAST]] | ||
===Ascites Fluid Workup=== | |||
*Cell count and differential | |||
*Albumin | |||
*Total protein | |||
*Only if suspicious:<ref name=Runyon2012>Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.</ref> | |||
**[[Gram stain]] | |||
**Glucose | |||
**LDH | |||
**Amylase | |||
**AFB smear and culture | |||
**Cytology | |||
**Triglyceride | |||
==Management== | ==Management== | ||
Revision as of 08:11, 3 May 2020
Background
- Abnormal buildup of peritoneal fluid
Clinical Features
- Abdominal distention +/- discomfort
- Fluid wave
- +/- SOB if massive amount
Causes
- Cirrhosis 81%[1]
- Malignancy 10%
- Heart failure 3%
- Tuberculosis 2%
- Other 4%
Complications
Differential Diagnosis
Ascites Diagnosis
The differential diagnosis of ascites is often clarified by the calculation of the serum albumin to ascites gradient (SAAG).^
- High SAAG > 1.1 g/dL – Indicative of portal hypertension[2]
- Cirrhosis
- Heart failure
- Ascites total protein > 2.5 g/dL suggests cardiac ascites[3]
- Alcoholic hepatitis
- Budd-Chiari syndrome
- Portal vein thrombosis
- Low SAAG < 1.1 g/dL
- Malignancy / peritoneal carcinomatosis
- Nephrotic syndrome
- Pancreatitis
- Peritoneal tuberculosis
- Serositis
- Bowel infarction
- Chylous
- ^SAAG = (serum albumin in g/dL) − (ascitic albumin in g/dL)
Evaluation
- Ascites in females with no other reason for it = gyn neoplasm until proven otherwise (ovarian cancer)
Workup
POCUS showing ascites[4]
Ascites Fluid Workup
- Cell count and differential
- Albumin
- Total protein
- Only if suspicious:[5]
- Gram stain
- Glucose
- LDH
- Amylase
- AFB smear and culture
- Cytology
- Triglyceride
Management
- Salt restriction
- Effective in about 15% of patients
- Diuretics
- Spironolactone
- Starting dose = 100mg/day PO (max 400mg/day)
- 40% of patients will respond
- Furosemide
- 40mg/day PO (max 160mg/day)
- Ratio of 100:40 with spironolactone (reduces risks of potassium prob)
- Spironolactone
- Water restriction
- Paracentesis
- Consider liver transplantation and shunting
Disposition
- Frequently outpatient, once SBP is ruled out, if a known reason for ascites and sufficiently therapeutically drained
See Also
References
- ↑ Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.
- ↑ Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.
- ↑ Runyon BA. Cardiac ascites: a characterization. J Clin Gastro. 1998; 10(4): 410-412.
- ↑ http://www.thepocusatlas.com/bowel/
- ↑ Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.