Diferencia entre revisiones de «Ascites»
Sin resumen de edición |
Sin resumen de edición |
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| Línea 2: | Línea 2: | ||
*Abnormal buildup of peritoneal fluid | *Abnormal buildup of peritoneal fluid | ||
== | ===Causes=== | ||
== | |||
*[[Cirrhosis]] 81%<ref>Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.</ref> | *[[Cirrhosis]] 81%<ref>Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.</ref> | ||
*Malignancy 10% | *Malignancy 10% | ||
| Línea 15: | Línea 9: | ||
*Other 4% | *Other 4% | ||
== | ==Clinical Features== | ||
[[File:Hepaticfailure.jpg|thumb|Cirrhotic abdomen secondary to ascites.]] | |||
* | *Abdominal distention +/- discomfort | ||
*[[ | *Fluid wave | ||
*+/- [[SOB]] if massive amount | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Línea 63: | Línea 58: | ||
==Disposition== | ==Disposition== | ||
*Frequently outpatient, once [[SBP]] is ruled out, if a known reason for ascites and sufficiently therapeutically drained | *Frequently outpatient, once [[SBP]] is ruled out, if a known reason for ascites and sufficiently therapeutically drained | ||
==Complications== | |||
*[[SBP]] | |||
*[[Hepatorenal syndrome]] | |||
*[[Pleural effusion]] | |||
==See Also== | ==See Also== | ||
Revisión del 16:17 4 jun 2020
Background
- Abnormal buildup of peritoneal fluid
Causes
- Cirrhosis 81%[1]
- Malignancy 10%
- Heart failure 3%
- Tuberculosis 2%
- Other 4%
Clinical Features
- Abdominal distention +/- discomfort
- Fluid wave
- +/- SOB if massive amount
Differential Diagnosis
Ascites Diagnosis
The differential diagnosis of ascites is often clarified by the calculation of the serum albumin to ascites gradient (SAAG).^
- High SAAG > 1.1 g/dL – Indicative of portal hypertension[2]
- Cirrhosis
- Heart failure
- Ascites total protein > 2.5 g/dL suggests cardiac ascites[3]
- Alcoholic hepatitis
- Budd-Chiari syndrome
- Portal vein thrombosis
- Low SAAG < 1.1 g/dL
- Malignancy / peritoneal carcinomatosis
- Nephrotic syndrome
- Pancreatitis
- Peritoneal tuberculosis
- Serositis
- Bowel infarction
- Chylous
- ^SAAG = (serum albumin in g/dL) − (ascitic albumin in g/dL)
Evaluation
- Ascites in females with no other reason for it = gyn neoplasm until proven otherwise (ovarian cancer)
Workup
POCUS showing ascites[4]
Ascites Fluid Workup
- Cell count and differential
- Albumin
- Total protein
- Only if suspicious:[5]
- Gram stain
- Glucose
- LDH
- Amylase
- AFB smear and culture
- Cytology
- Triglyceride
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
Complications
See Also
References
- ↑ Runyon BA. Care of patients with ascites. N Eng J Med. 1994; 330: 337-342.
- ↑ Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.
- ↑ Runyon BA. Cardiac ascites: a characterization. J Clin Gastro. 1998; 10(4): 410-412.
- ↑ http://www.thepocusatlas.com/bowel/
- ↑ Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Amer Assoc Study Liv Dis. 2012; 1-96.