Download to read offline
More Related Content
Similar to Presentation ascites approach,DDs, management.pptx
![Complications of liver cirrhosis –ascites and portal [Autosaved].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/complicationsoflivercirrhosisascitesandportalautosaved-241125182125-3f7ec487-thumbnail.jpg?width=640&height=640&fit=bounds)
![Ascites clinical review [autosaved]](https://cdn.slidesharecdn.com/ss_thumbnails/ascitesclinicalreviewautosaved-210803074107-thumbnail.jpg?width=640&height=640&fit=bounds)
More from AnujaJacob5
Presentation ascites approach,DDs, management.pptx
- 1.
- 2. Abdominal Swelling ▪ Numerous causes ▪Usual complaint is sensation of bloating/fullness/increase in girth size(belt/clothes) ▪ Abdominal pain is unusual. ▪ If Pain+swelling:> associated infection, peritonitis or pancreatitis to be r/o. ▪ If Ascites is the cause,new onset of inguinal/umblical hernia. ▪ Dyspnea
- 3.
- 4. FLATUS ▪ Normal..200 ml ▪N2,02(consumed) ▪ CO2, Hydrogen,Methane(intraluminally produced) Causes of increased abdominal gas ▪ Aerophagia ▪ Bacterial metabolism of excess fermentable substances(lactose and other oligosaccharides) ▪ Impaired Gas transit (IBS)
- 5. FAT ▪ Weight gain ▪Imbalance between calory intake and energy expenditure+poor diet &sedentary lifestyle ▪ Cushing syndrome ▪ Risk for insulin resistance and cardiovascular disease.
- 6. Fetus ▪ Pregnancy ▪ 12-14weeks ,uterus abdominal organ ▪ Seen before due to fluid retention/relaxation of abdominal muscles.
- 7. Feces ▪ Severe constipation ▪Intestinal obstruction/paralytic ileus. ▪ Accompanied by pain/nausea/vomiting
- 8. FatalGrowth ▪ Neoplasm ▪ Abscess ▪Cyst ▪ Organomegaly(hepatomegaly, splenomegaly, abdominal aortic aneurysm,bladder distension)
- 9. Fluid ▪ Ascites ▪ Tobe discussed in detail ▪ Grade 1-USG ▪ Grade 2-Physical examination 1.5 L ▪ Grade 3-Marked abdominal distension
- 10. APPROACHTOA PATIENT ▪ Symptoms suggestiveof malignancy ▪ Symptoms of intestinal obstruction ▪ Symptoms of paralytic ileus ▪ Symptoms of Aerophagia ▪ Symptoms of CLD ▪ Past history of TB,heart failure, valvular heart disease
- 11. Examination ▪ General examination ▪Pallor ▪ Icterus ▪ Clubbing ▪ Lymphadenopathy (Virchows) ▪ Edema ▪ Stigmata of Chronic liver disease.
- 12. System examination ▪ Inspection ▪ Palpation(tenderness,liver,spleen) ▪Percussion(gas or fluid) ▪ Auscultation(bowel sounds&hum)
- 13. Othersystems ▪ CVS ▪ JVP ▪Pericardial Knock ▪ MURMUR
- 14. Investigation ▪ Blood tests- ▪CBC,PT/INR,LFT including Total Protein/Albumin,S.Amylase,Lipase ▪ Urine protein ▪ Detection of gases in expired air(Hydrogen&Methane) ▪ Abdominal Xray ▪ USG ▪ CT scan ▪ Selected cases..Hepatic venous pressure gradient ▪ Liver biopsy
- 15. ASCITES ▪ CAUSES 1. Cirrhosis(84%) 2.Others ▪ Cardiac Ascites ▪ Peritoneal carcinomatosis ▪ Hepatic metastasis ▪ Infection (Tb/Chlamydia) ▪ Pancreatitis ▪ Renal disease (Nephrotic syndrome) ▪ Hypothyroidism ▪ Familial Mediterranean fever
- 16. Pathogenesisin Cirrhosis ▪ 1****Portal Hypertension ▪Pressure=Flow*Resistance 1. Development of hepatic fibrosis 2. Activation of hepatic stellate cells 3. Decrease in eNOS production-decrease in NO production and increased intrahepatic vasoconstriction. 4. Increased systemic circulating levels of NO 5. Increased levels of vascular endothelial growth factor, Tumor necrosis factor—splanchnic artery vasodilatation. ▪ Hypvolemia to Kidney ▪ Compensatory increase in ADH-vasoconstriction-free water retention & Activation of sympathetic nervous system and RAAS-Sodium and water retention. ▪ 2**Hypoalbuminemia
- 17. Pathogenesisin othercases ▪ Primary peritonealmalignancy ▪ Abdominal malignancy ▪ Mets from breast, lung,melanoma ▪ Tuberculous peritonitis ▪ Pancreatic Ascites
- 18. Evaluationof Ascites ▪ Paracentesis ▪ Technique ▪Complications ▪ Interpretation 1. Appearance 2. Albumin 3. TC,DC 4. Grams stain and culture
- 19. Apperance ▪ Turbid.. Infection ▪White milky …Chylous..TG--)200 1. Trauma 2. Cirrhosis 3. Tumor 4. Tuberculosis 5. Congenital anomalies ▪ Dark brown..biliary tract perforation ▪ Black fluid..pancreatic necrosis/metastatic melanoma
- 20.
- 21. Tor/oDD’s Investigation ▪ NTPro BNP ▪Ascites glucose and LDH ▪ Ascites Amylase ▪ Cytology(peritoneal carcinomatosis, TB) ▪ Ascitic ADA/AFB smear/culture ▪ When causes are unclear 1. Laporotomy/Laproscopy with peritoneal biopsy
- 22. Treatment ▪ Restriction ofsalt intake to 2g/day. ▪ Diuretics(Spironolactone(amiloride*)& Furosemide)400/160 ▪ Refractory 1. Alpha 1 adrenergic agonist/Midodrine 2. Alpha 2 adrenergic agonist/clonidine 3. Large volume paracentesis(Albumin infusion) 4. TIPS(hepatic encephalopathy) 5. Alfapump system 6. Malignant ascites(LVP,transcutaneous drainage catheter,peritoneovenous shunt,Alfapump) 7. Tb peritonitis..ATT 8. Noncirrhotic Ascites of other causes-correction of precipitating condition.
- 23. COMPLICATIONS SBP ▪ Symptoms..Fever, increasein abdominal girth,vomiting,hepatic encephalopathy ▪ O/E..Abdomen tender(40%) ▪ PMN>=250/micro litre ▪ Culture ▪ MC organism..Ecoli, Klebsiella,Streptococci.Enterococci ▪ Treatment :IV Cefotaxime
- 24. Prevention ▪ Upper GIbleed…Oral ciplox/norflox/IV Ceftriaxone ▪ Diuretics..increase activity of Ascitic fluid protein opsonins…decrease risk of SBP
- 25. 2**HEPATIC HYDROTHORAX ▪ CF:Dyspnea,hypoxiaor infection ▪ Rx:dyspnea;hypoxia;infection ▪ Rx:sodium restriction,diuretics,thoracocentesis or TIPS.