Ascites: Difference between revisions
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*[[SBP]] | *[[SBP]] | ||
*[[Hepatorenal syndrome]] | *[[Hepatorenal syndrome]] | ||
*Portal/splenic vein thrombosis | *[[Portal vein thrombosis]]/splenic vein thrombosis | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 21:43, 2 March 2020
Background
- Abnormal buildup of peritoneal fluid
Clinical Features
- Abdominal distention +/- discomfort
- Fluid wave
- +/- SOB if massive amount
Complications
- SBP
- Hepatorenal syndrome
- Portal vein thrombosis/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