DR Medhat MRCP

Ascites :
- i.e accumulation of fluid in peritoneal cavity.
- To be detected clinically, it should be at least moderate ascites (i.e > 1.5 L).
• Classification (causes):
Old classification
Transudate (protein < 30g/l), causes: Exudate (protein > 30g/l) causes:
Cirrhosis and portal hypertension Intra-abdominal tuberculosis.
Nephrotic syndrome
Pancreatitis.
Cardiac failure
Hepatic or peritoneal malignancy
Budd–Chiari syndrome
Myxodema.
- However the serum-ascites albumin gradient (SAAG) has now largely replaced this
concept and is the best single test for classifying ascites into :
Portal hypertensive (SAAG >1.1 g/dL) causes.
Non–portal hypertensive (SAAG 1.1 g/dL) , causes:
↓ SAGG (< 1.1 g/dL), causes:
Cirrhosis.
Nephrotic syndrome.
Alcoholic hepatitis.
Protein losing enteropathy.
Schistosomiasis.
Peritoneal carcinomatosis.
Fulminant hepatic failure.
Tuberculous peritonitis.
Budd–Chiari syndrome.
Pancreatic duct leak.
Acute or chronic portal vein obstruction. Biliary ascites.
Cardiac diseases.
SBP secondary to cirrhosis.
• Investigations : U.S + diagnostic tapping (cell count,SAAG,amylase,C/S,AFB,cytology)
• Management of ascites :
1) Dietary salt restriction (< 5.2 gm /day).
2) Diuretics : spironolactone (upto 400 mg/day) + frusemide (40-160 mg/day).
3) TTT of refractory ascites (i.e resistant to TTT for 1 week, or intolerant to diuretics`SE`)
Therapeutic tapping : 3-5 L/ session with I.V albumin 10 g /every 1 L removal.
TIPS (transjugular intrahepatic porto-systemic shunt) refractory ascites
Liver transplantation.
Portal HTN bleeding
Hepato-renal failure
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