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ascites

ascites

Pathogenesis

Management of transudative ascites

mild:

mod-severe ascites:

  • as for mild, plus,
  • consider admission to hospital for RIB, daily weighs, monitoring fluid balance, urine output, renal function.
  • send ascitic fluid to exclude spontaneous bacterial peritonitis (SBP)
  • spironolactone 100mg o mane, increase dose by 100mg/day every 4-7 days prn to max. 400mg/d
  • if ascites prominent or refractory to above, add:
  • if tense ascites or refractory, consider paracentesis over 1-3hrs to drain ascitic fluid:
    • if > 5L removed then infuse albumin 6-8g per L ascites removed

intractable acites:

  • requires specialised care with consideration of:
    • repeated paracentesis
    • reduction in portal pressure via:
      • operative portosystemic shunt
      • percutaneous insertion of shunt between hepatic & portal vein
        • transjugular intrahepatic portosystemic shunt (TIPS)
    • peritoneovenous shunt to drain ascites from peritoneum into SVC (Le Veen shunt)
    • liver transplantation
ascites.txt · Last modified: 2013/08/18 00:32 (external edit)