ascites (quick hits)

30 Oct

About 85% of cases of ascites are attributed to cirrhosis.

The 2nd most common cause is cancer.

The 3rd most common is heart failure.

Less common causes include renal failure/dialysis, nephrotic syndrome, lupus, inflammatory GI disorders, pancreatic disease, thoracic duct obstruction, and tuberculosis.

When the most common etiology is not found, the other possibilities should be explored.

Ascites is classified as grade 1 (mild) to grade 3 (large) and also by response to diuretic treatment.

Although paracentesis is commonly performed for ascites from liver disease, ascetic cytology for cancer is expensive and can low yields (reported at 7%), multiple samples increases sensitivity.

Therapeutic paracentesis can take off up to 5L of fluid safely for symptom resolution, but does not treat the cause of the ascites.

 

Submitted by C. Stokes.

 

References: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th Edition; Rosen’s Emergency Medicine. (2010); picture

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