Ascites: Difference between revisions
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==Background== | ==Background== | ||
*Abnormal buildup of peritoneal fluid | |||
==Clinical Features== | ==Clinical Features== | ||
*Abdominal distention | *Abdominal distention +/- discomfort | ||
*Fluid wave | *Fluid wave | ||
*+/- [[SOB]] if massive amount | |||
===Complications=== | |||
*[[SBP]] | |||
*[[Hepatorenal syndrome]] | |||
*Portal/splenic vein thrombosis | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Chem 7 | *Chem 7 | ||
*PT/PTT | *PT/PTT | ||
*LFTs + lipase | *[[LFTs]] + lipase | ||
*[[FAST]] | *[[FAST]] | ||
Revision as of 19:26, 29 September 2019
Background
- Abnormal buildup of peritoneal fluid
Clinical Features
- Abdominal distention +/- discomfort
- Fluid wave
- +/- SOB if massive amount
Complications
- SBP
- Hepatorenal syndrome
- Portal/splenic vein thrombosis
Differential Diagnosis
- REDIRECT Template:Ascites Evaluation
Evaluation
- Ascites in females with no other reason for it = gyn neoplasm until proven otherwise (ovarian cancer)
Workup
POCUS showing ascites[1]
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
- 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