Ascites resident survival guide
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|[[Ascites resident survival guide#Abdominal paracentesis|Abdominal paracentesis]]|
Accumulation of fluid within the peritoneal cavity results in ascites. Most important for a successful treatment of ascites is an accurate diagnosis of its cause. Most common causes are portal hypertension, malignancy and heart failure. The diagnosis is made with a combination of physical examination and abdominal imaging. The next step is typically a paracentesis to evaluate the ascitic fluid for causes.
Ascites can be classified based on the underlying causes. Common causes are:
❑ Chylous ascites
A grading system for ascites has been proposed by the International Ascites Club:
❑ Grade 1:Mild ascites detectable only by ultrasound examination
❑ Grade 2:Moderate ascites manifested by moderate symmetrical distension of the abdomen
❑ Grade 3:Large or gross ascites with marked abdominal distension
Complete Diagnostic Approach
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.
History and symptoms:
❑ Hints for etiology (i.e. signs and symptoms for cirrhosis, malignancy)?
❑ Vital signs:
❑ General appearance:
❑ Complete blood count
Imaging and additional tests:
❑ Ultrasound with Doppler:
❑ Consider computed tomographic (CT)
It is a bedside or clinic procedure in which a needle is inserted into the peritoneal cavity and ascitic fluid is removed. It can be used therapeutic or diagnostic.
- Runyon BA, AASLD (2013). "Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012". Hepatology. 57 (4): 1651–3. doi:10.1002/hep.26359. PMID 23463403.
- Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F; et al. (2003). "The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club". Hepatology. 38 (1): 258–66. doi:10.1053/jhep.2003.50315. PMID 12830009.
- Runyon BA, AASLD Practice Guidelines Committee (2009). "Management of adult patients with ascites due to cirrhosis: an update". Hepatology. 49 (6): 2087–107. doi:10.1002/hep.22853. PMID 19475696.