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Friday, September 17, 2021

Ascites: Causes Symptoms Treatment by Nurses Note


Definition of  Ascites

Ascites is the accumulation of free fluid in the peritoneal cavity.

Diagnosis Study for Ascites

1. Generalized distension of abdomen with more fullness in the flanks.

2. Shifting fullness can diagnosis 500 ml fluid.

3. Horse-shoe-shaped can diagnose 1-litre fluid.

4. Fluid thrill seen in Tense ascites.

5. Other signs:

  • Transversely stretched umbilicus.
  • Divarication of recti.
  • Tense and shiny skin.
  • Widened subcostal angle.
  • Lower ribs pushed outwards and upwards.
6. Diagnosis of small quantity of fluid (puddle sign): The patient is put in knee-chest position so that the fluid gravitates down to the anterior abdominal wall. The stethoscope is placed over this and the anterior abdominal wall is to flicked for a puddle sound. This can diagnose even 150 mL gluid.

Causes Ascites

1. Transudates
  • Cardiac Failure
  • Hypoproteinemia
  • Anaemia
  • Beriberi
  • Nephrotic syndrome
  • Portal Hypertension
  • Epidemic hypertension
  • Polyserositis
  • Meigs syndrome
2. Exudates
  • Peritoneal disease
    • Infections: Tuberculosis, bacterial, fungal and parasitic infections.
    • Neoplasms.
  • Collagen disorders.
  • Eosinophilic gastroenteritis.
  • Gynaecological: Endometriosis.
3. Miscellaneous
  • Pancreatic
  • Bile
  • Chylous
  • Myxedema

Mechanism of Ascites Production

1. Increased hydrostatic pressure intravascularly.

2. Decreased osmotic pressure intravascularly due to hypoproteinemia.

3. Increased osmotic pressure extravascularly.

4. Increased lymphatic pressure.

Causes of Hemorrhagic Fluid

1. Trauma of thoracic duct.

2. Parasite infections.

3. Tuberculosis.

4. Thrombosis of subclavian vein.

5. Malignancy involving thoracic duct.

Causes of purulent Fluid

1. Abdominal infections.

2. Penetrating wound of abdomen.

3. Pyemia and septicemia.

4. Ruptured amebic liver abscess.

5. Pelvic inflammatory disease.

Causes of Ascites Disproportionate to Edema of Feet.

1. Cirrhosis of liver.

2. Constrictive pericarditis.

3. Restrictive cardiomyopathy.

4. Hepatic venous occlusion.

5. Tuberculous peritonitis.

6. Intra-abdominal tumor.

Management of Ascites

1. Treatment of Cause.

2. Diet: Low sodium diet.

3. Diuretics: Spironolactone or furosemide or combination.

4. Abdominal paracentesis if cardiorespiratory embarrassment with or without albumin.

5. TIPS ( Transjugular intrahepatic portosystemic shunt).

6. Porta venous shunts for refractory ascites.

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