ASCITES

• Ascites means accumulation of free fluid in the peritoneal cavity.

 Etiology-

• Most common cause is portal hypertension secondary to cirrhosis.
• Tuberculous peritonitis (common cause of non- portal hypertension ascites)

Clinical features-

• Atleast 1-2 L of fluid accumulation required to cause ascites.
• Abdominal distension, fullness in the flanks, dullness on percussion & fluid thrill.
• Elevated umbilicus, scrotal oedema and dilated abdominal veins.
• Massive ascites associated with hepatic hydrothorax.

Investigations-

• USS is the best investigations of detecting ascites.
• SAAG= serum albumin- ascites

• WBC increased

Treatment-

• Salt restriction- mild ascites
• Moderate ascites- spironolactone (diuretics), furosemide
• First line treatment of refractory ascites- large volume paracenetesis + Albumin
• TIPSS (transjugular intrahepatic portosystemic stent shunt)- resistant ascites