Ascites

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Background

Clinical Features

  • Abdominal distention
  • Fluid wave

Differential Diagnosis

Ascites

Evaluation

  • Ascites in females with no other reason for it = gyn neoplasm until proven otherwise (ovarian cancer)

Workup

POCUS showing ascites[1]
  • 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

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/