Ascites: Difference between revisions

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[[Category:GI]]
[[Category:GI]]
[[Category:Symptoms]]

Revision as of 19:30, 29 September 2019

Background

  • Abnormal buildup of peritoneal fluid

Clinical Features

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

Complications

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[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

  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

References

  1. ↑ http://www.thepocusatlas.com/bowel/
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