Ascites: Difference between revisions
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+ | == Differential Diagnosis == |
+ | * Hepatic |
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+ | ** [[Cirrhosis]] |
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+ | ** [[Alcoholic hepatitis]] |
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+ | ** [[Acute liver failure]] |
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+ | ** [[Budd-Chiari syndrome]] |
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+ | ** [[Sinusoidal obstruction syndrome]] |
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+ | ** [[Sarcoidosis]] |
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+ | ** [[Polycystic liver disease]] |
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+ | ** [[Nodular regenerative hyperplasia]] |
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+ | * Cardiac |
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+ | ** [[Heart failure]] |
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+ | ** [[Constrictive pericarditis]] |
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+ | ** [[Pulmonary hypertension]] |
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+ | * Neoplastic |
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+ | ** [[Hepatocellular carcinoma]] |
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+ | ** [[Liver metastases]] |
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+ | ** [[Peritoneal carcinomatosis]] |
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+ | ** [[Malignant chylous ascites]] |
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+ | * Infectious |
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+ | ** [[Peritoneal tuberculosis]] |
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+ | ** Secondary bacterial [[peritonitis]] |
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+ | * Other |
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+ | ** [[Nephrotic syndrome]] |
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+ | ** [[Pacreatitis]] |
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+ | ** [[Mixedema]] |
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+ | ** Post-operative lymphatic leak |
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+ | == Investigations == |
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+ | * Ultrasound or CT abdomen to look for fluid and any underlying lesions |
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+ | * Diagnostic [[paracentesis]] |
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+ | ** Albumin and protein, to calculated serum-ascites albumin gradient |
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+ | ** Cell count and differential (PMN≥250 suggests [[SBP]]) |
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+ | ** Gram stain and culture |
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+ | ** ± acid-fast stain and culture |
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+ | ** ± CEA and ALP |
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+ | ** ± cytology |
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+ | ** ± CA-125 |
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− | === |
+ | === Serum-Ascites Albumin Gradient === |
+ | * SAAG = serum albumin - ascites albumin |
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+ | * SAAG ≥11 g/L suggests portal hypertension |
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+ | * SAAG <11 g/L suggests a cause other than portal hypertension |
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+ | ==Management== |
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+ | ===Spontaneous Bacterial Peritonitis=== |
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[[Category:Gastroenterology]] |
[[Category:Gastroenterology]] |
Latest revision as of 10:48, 2 August 2020
Differential Diagnosis
- Hepatic
- Cardiac
- Neoplastic
- Infectious
- Peritoneal tuberculosis
- Secondary bacterial peritonitis
- Other
- Nephrotic syndrome
- Pacreatitis
- Mixedema
- Post-operative lymphatic leak
Investigations
- Ultrasound or CT abdomen to look for fluid and any underlying lesions
- Diagnostic paracentesis
- Albumin and protein, to calculated serum-ascites albumin gradient
- Cell count and differential (PMN≥250 suggests SBP)
- Gram stain and culture
- ± acid-fast stain and culture
- ± CEA and ALP
- ± cytology
- ± CA-125
Serum-Ascites Albumin Gradient
- SAAG = serum albumin - ascites albumin
- SAAG ≥11 g/L suggests portal hypertension
- SAAG <11 g/L suggests a cause other than portal hypertension
Management
- Sodium restrict < 88 mmol/day (5 g/day of salt)
- Diuretics: spironolactone 100 mg po daily + furosemide 40 mg po daily
- Titrate up every few days, to maximum of 400 mg / 160 mg
Refractory Ascites
- Defined by urinary sodium excretion <78 mmol/24h despite maximal tolerated diuretics
- May be limited by diuretic effects
Spontaneous Bacterial Peritonitis
- Diagnosed by ascitic fluid neutrophils >250 or culture positive
- Treat with ceftriaxone 2g q24h for 5-7 days