Ascites

Background

Clinical Features

  • Fluid wave

Differential Diagnosis

Diagnosis

Workup

  • CBC
  • Chem 7
  • PT/PTT
  • LFTs + lipase
  • FAST

SBP Work-Up of Ascitic Fluid via Paracentesis

  • Cell count with differential
  • Gram stain
  • Culture (10cc in blood culture bottle)
  • Glucose
  • Protein

Consider

  • Albumin and SERUM albumin
  • LDH and SERUM LDH at same time
  • Amylase

Specific circumstances

  • TB smear and culture
  • Cytology
  • TG
  • Billirubin

Management

  1. Salt restriction
    • Effective in about 15% of patients
  2. Diuretics
    • Spironolactone
      • Starting dose = 100mg/day PO (max 400mg/day)
      • 40% of patients will respond
    • Furosemide
      • 40 mg/day PO (max 160 mg/day)
      • Ratio of 100:40 with spironolactone (reduces risks of potassium prob)
  3. Water restriction
  4. Paracentesis
  5. Consider liver transplantation and shunting

Disposition

See Also