ascites
Table of Contents
ascites
see also gastroenterology, cirrhosis
Pathogenesis
- usually transudative due to either:
- elevated portal venous pressures
- hypoalbuminaemia
- enhanced renal retention of sodium
- uncommonly, it is exudative as in:
- neoplasia / cancer / tumours such as:
- peritoneal carcinomatosis
Management of transudative ascites
mild:
- Rx underlying liver disease if possible
- Rx precipitants such as infections
- avoid salt in diet
- avoid drugs that:
- promote sodium retention (eg. non-steroidal anti-inflammatory drugs (NSAIDs))
- contain large amounts of sodium (eg. antacids, aspirin (acetylsalicylic acid), effervescent preparations)
- ensure adequate protein intake unless hepatic encephalopathy
- if symptomatic (eg. discomfort, distension):
- spironolactone 50-100mg o mane
mod-severe ascites:
- as for mild, plus,
- consider admission to hospital for RIB, daily weighs, monitoring fluid balance, urine output, renal function.
- send ascitic fluid to exclude spontaneous bacterial peritonitis (SBP)
- spironolactone 100mg o mane, increase dose by 100mg/day every 4-7 days prn to max. 400mg/d
- if ascites prominent or refractory to above, add:
- frusemide / furosemide / Lasix 40mg o mane
- can use higher doses but may ppt hypokalaemia or aggravate renal impairment
- if tense ascites or refractory, consider paracentesis over 1-3hrs to drain ascitic fluid:
- if > 5L removed then infuse albumin 6-8g per L ascites removed
intractable acites:
- requires specialised care with consideration of:
- repeated paracentesis
- reduction in portal pressure via:
- operative portosystemic shunt
- percutaneous insertion of shunt between hepatic & portal vein
- transjugular intrahepatic portosystemic shunt (TIPS)
- peritoneovenous shunt to drain ascites from peritoneum into SVC (Le Veen shunt)
- liver transplantation
ascites.txt · Last modified: 2013/08/17 14:32 by 127.0.0.1