ASCITES

• Ascites is the accumulation of fluid within the peritoneal cavity.

• Most common cause of ascites is portal hypertension related to
cirrhosis.
• Malignant or infections can also cause ascites
• Differentiation of these other causes are important for patient care.
Clinical Features
• Increase in abdominal girth. Accompanied by the development of
peripheral edema.
• Development of ascites is often insidious.
• Patients usually have 1-2 L pf fluid in the abdomen before they are
aware that there is an increase.
• If massive, respiratory function can be compromised causing shortness
of breath.
• Hepatic hydrothorax may also occur.
• Patients with massive ascites are often malnourishes and have muscle
wasting and excessive fatigue and weakness.
Diagnosis
• By physical examination aided by abdominal imaging.
• Patients will have bulging flanks, may have a fluid wave or presence of
shifting dullness.
• Subtle amounts of ascites can be detected by ultrasound or CT
scanning.
• Recommended diagnostic for patients with ascites for the first time
is paracentesis to characterize the fluid.
• In patients with cirrhosis, the protein concentration of the ascites
fluidis low, majority will have a concentration of <1g/dL.
Treatment
• Small amounts of ascites can be managed with dietary sodium restriction alone.
• <2g of sodium per day is recommended amount.
• Eat fresh or frozen food, avoiding canned or processed foods.

• Moderate ascites: diuretic therapy is usually necessary.

                                    Spironolactone at 100 –200 mg/d as a single dose
                                     Furosemide may be added at 40 –80 mg/d in patients with
peripheral edema.
• Alternative treatment including repeated large volume paracentesis or TIPS
procedure should be considered.