Saturday, May 25, 2013

Managment of Ascites

Ascites is our topic today so we will start by Ascites definition

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Ascites and paracentesis

Definition of Ascites:



Ascites is the collection of excess free fluid in the peritoneal cavity.

Causes of Ascites:

Hepatic :
  • Liver Cirrhosis.
  • Hepatic tumors (hepatocellular carcinoma)
Malignant Disease:
  • Hepatocellular carcinoma
  • Abdominal or pelvis tumors that may be primary or secondary tumors
  • Primary mesothelioma

Cardiac:
  • Congestive Cardiac failure or right heart faliure
  • Constrictive pericarditits.
  • Tricuspid incompetence (regurge)
Renal:
Peritonitis:
Venous obstruction:
  • Budd-Chiari syndrome.
  • Veno-occlusive disease.
  • Hepatic portal vein obstruction.
  • Inferior vena cave obstruction.
Gastrointestinal:
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 Management of Ascites:
Watch this video (paracentesis):

General Investigations:
1. Urine Dipstick:  strongly positive for protein in nephrotic syndrome.
2. Complete Blood Count: Raised white cell count may indicate an infection
3. Urea and Electrolytes: Elevated urea and creatinine may indicate a renal etiology
4. LFT’s :in hepatic faliure.
5. Chest X-ray: Findings suggestive of cardiac failure are cardiomegaly.
6. Ultrasound Abdomen: detect any intra abdominal masses that are not palpable on clinical examination. OR fatty deposits in the liver in the presence of cirrhosis.
7. Abdominal Paracentesis: Aspiration of the ascitic fluid is very useful to help determine the underlying cause. A sample should be sent to microbiology  clinical chemistry and pathology.
8.Ascitic fluid Examinations.
9.Others:
A. Echocardiography
B. Liver biopsy
C. Renal Biopsy
D. Portal venography

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