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
- Salt restriction
- Effective in about 15% of patients
- 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)
- Spironolactone
- Water restriction
- Paracentesis
- Consider liver transplantation and shunting