Summary
Summary An Approach to Ascites
- Course
- Medicine
- Institution
- University Of Cape Town (UCT)
This provides a one page summary for the approach to ascites.
[Show more]
Seller
Follow
Content preview
Ascites- Ascites
o Fluid Thrill (hands on flanks, tap one side, and feel thrill on
other side)
o Shifting Dullness
- Note: the umbilicus may be everted in ascites
Causes of Ascites:
Transudate Exudate
(high serum:ascites albumin (low serum:ascites albumin
conc. gradient) conc. gradient)
Cirrhosis (75%) Tuberculosis
- Mainly due to alcoholic Pathophysiology of Ascites:
cirrhosis Nephrotic Syndrome (<10% of
- May be viral or patients) Ascitic fluid can accumulate as a transudate or
cryptogenic as well an exudate. Amounts of up to 25 liters are
Peritoneal Ca (malignancy possible.
Heart failure (5%) accounts for 10% of ascites) Roughly, transudates are a result of increased
pressure in the portal vein e.g. due to cirrhosis,
(primary/metastatic)
while exudates are actively secreted fluid due to
Other: inflammation or malignancy.
Kwashiokor (protein Pancreatitis As a result, exudates are high in protein, high in
malnutrition) lactate dehydrogenase, have a low pH (<7.30), a
Constrictive Pericarditis low glucose level, and more white blood cells.
Transudates have low protein (<30g/L), low LDH,
high pH, normal glucose, and fewer than 1 white
cell per 1000 mm³. Clinically, the most useful
Investigations: measure is the difference between ascitic and
serum albumin concentrations. A difference of
- Peritoneal Paracentesis
less than 1 g/dl (10 g/L) implies an exudate.
o Check for Albumin, LDH, pH, Glucose and WCC
o Can be used therapeutically as well Portal hypertension plays an important role in
- Ultrasound the production of ascites by raising capillary
o May detect smaller volumes hydrostatic pressure within the splanchnic bed.
o May help guide paracentesis
- Serum-to-ascites Albumin Gradient (SAAG)
o Useful to classify ascites and may lead to underlying cause
Diuretic regimen:
Treatment:
- Spironolactone (aldosterone antagonist)
- Restrict Salt intake
o 100mg single morning dose
- Restrict water intake
- Furosemide (loop diuretic)
- Diurese the patient
o 40mg single morning dose
- Tense Ascites:
o 4-6L abdominal peritoneal paracentesis
o Then continue with salt restriction and diuretics
Prognosis:
- 50% of cirrhotic patients with ascites die within two years
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through EFT, credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying this summary from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller maximusmeridius. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy this summary for R50,00. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
73918 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy summaries for 14 years now