5 Ascites Free Online FlashCards

What is ascites, and what commonly drives it in cirrhosis?

Ascites is abnormal fluid accumulation in the peritoneal cavity. In cirrhosis, portal hypertension and renal sodium and water retention are major contributors.

What procedure is important for evaluating new ascites?

Perform diagnostic paracentesis when fluid is accessible. New ascites should be evaluated for its cause and complications.

What initial tests are generally used to evaluate ascitic fluid?

Test ascitic fluid for cell count and differential, albumin, and total protein. Measure serum albumin at the same time to calculate the SAAG.

How is SAAG calculated, and what does a high result suggest?

Calculate SAAG as serum albumin minus ascitic-fluid albumin. A result of $1.1\ \text{g/dL}$ or higher suggests portal hypertension contributes to the ascites.

What fluid pattern can support a cardiac cause of ascites?

A high SAAG with ascitic-fluid protein commonly greater than $2.5\ \text{g/dL}$ supports a cardiac contribution. It is a clue, not a stand-alone diagnosis.

Should a hospitalized patient with cirrhosis and ascites undergo paracentesis without typical infection symptoms?

Yes. Prompt diagnostic paracentesis is recommended for emergently hospitalized patients with cirrhosis and ascites, even without fever or abdominal pain.

What ascitic-fluid neutrophil count meets the usual SBP threshold?

An ascitic-fluid polymorphonuclear leukocyte count of at least $250\ \text{cells/mm}^3$ meets the usual threshold for SBP. Start empiric antibiotics promptly after obtaining appropriate cultures.

When should ascitic-fluid cultures be collected relative to antibiotics?

When infection is suspected, collect ascitic-fluid culture before antibiotics.

What are first-line principles for moderate cirrhotic ascites?

Use moderate sodium restriction of about $2\ \text{g}$ daily and diuretics, commonly spironolactone with or without a loop diuretic. Monitor weight, kidney function, and serum sodium and potassium.

When is fluid restriction generally needed for cirrhotic ascites?

Fluid restriction is generally unnecessary unless clinically important hyponatremia is present. Avoid excessive dietary restriction that could worsen malnutrition.

What is a common initial treatment for tense, uncomfortable ascites?

Large-volume paracentesis is commonly used as an initial treatment for tense ascites causing substantial discomfort.

When is albumin recommended after large-volume paracentesis?

When more than $5\ \text{L}$ is removed, albumin replacement is recommended. Guidance describes $6$–$8\ \text{g}$ of albumin per liter removed.