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Ascites (Clinical Presentation (History: (Drugs?, Weight loss?, How has…
Ascites
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Main Causes
Low protein
- With less protein e.g. albumin there is an inability to pull fluid back into the intravascular space
- This fluid then accumulates in the peritoneum
- Seen in hypoalbuminaemia, nephrotic syndrome and malnutrition
Low Flow
- Fluid can't move forwards through system e.g. due to a clot
- Raises pressure in vessels causing fluid to leak out of the vessels
- Seen in cirrhosis, Budd-Chiari syndrome, cardiac failure, constrictive pericarditis
Local inflammation
- Typically with peritonitis or intra-abdominal surgery
- Local inflammation leads to fluid accumulation
- Seen in peritonitis, abdominal cancers (esp. ovarian), infection e.g. TB
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Diagnosis
Diagnostic aspiration of 10-20ml of fluid using ascitic tap:
- Raised white cell count - indicative of bacterial peritonitis
- Gram stain and culture
- Cytology to find malignancy
- Amylase to exclude pancreatic ascites
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