Liver & GIT
First line of treatment in Ascites is:(PGI May 08)
Ascites is the accumulation of excess fluid within the peritoneal cavity.
i. The accumulation of ascitic fluid represents a state of total body sodium and water excess.
ii. Therefore dietary salt restriction is the cornerstone of therapy.
iii. Abdominal ultrasound may detect as little as 100 ml of ascitic fluid ultrasound is thus a useful investigation for the diagnosis of minimal ascites.
iv. Hemorrhagic ascites is diagnosed when RBC count >10,000 / mm3
An RBC count of 10,000 / mm3 is the threshold for pink appearance and hemorrhagic ascites is thus diagnosed when ascitic RBC count is >10,000 / mm3
Patho physiology of ascites:
1. Decrease albumin
2. Increase aldosterone
(a) Due to decrease Renal Blood Flow (b) Reduce aldosterone metabolism.
Clinical Management of Ascites
1. The first line treatment of ascites is dietary salt & water restriction.
2. Diuretic therapy:
a. Spironolactone, Eplerenone (new aldosterone receptor blocking drug)
b. Loop diuretics
a. For diagnosis (new onset ascites; suspicion of malignant ascites or spontaneous bacterial peritonitis).
b. Therapeutic maneuver (when tense ascites causes significant discomfort or respiratory compromise).
4. TIPS - Transjugular intrahepatic portosystemic shunts
Shunts (TIPS) may be used in cases of refractory ascites in whom recurrent paracentesis is too frequent or poorly tolerated.
Remember this about Ascites
. Ascites → Collection of >25 ml of peritoneal fluid
. Shifting dullness →Can be demonstrated when ascitic fluid > 500 ml
. Ultrasound → Can detect ascitic fluid up to 100 ml.