Ascites

Background

• Abnormal buildup of peritoneal fluid

Clinical Features

• Abdominal distention +/- discomfort
• Fluid wave
• +/- SOB if massive amount

Causes

• Cirrhosis 81%
• Malignancy 10%
• Heart failure 3%
• Tuberculosis 2%
• Other 4%

Complications

• SBP
• Hepatorenal syndrome
• Pleural effusion

Differential Diagnosis

1. 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

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

Ascites Fluid Workup

• Cell count and differential
• Albumin
• Total protein
• Only if suspicious:
  • Gram stain
  • Glucose
  • LDH
  • Amylase
  • AFB smear and culture
  • Cytology
  • Triglyceride

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
     • 40mg/day PO (max 160mg/day)
     • Ratio of 100:40 with spironolactone (reduces risks of potassium prob)
3. Water restriction
4. Paracentesis
5. 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

• Jaundice
• Paracentesis
• SBP