DISEASES:Ascites

ASCITES

Definition : An excessive pathological accumulation of free fluid in peritoneal cavity is called Ascites. Healthy man have little or n intraperitoneal fluid, but women may normally have as much as 20ml depending on the phases of menstrual cycle. In short collection of fluid in peritoneal cavity is known as Ascites.

CAUSES

1.Cirrhosis of liver 

2.malignant disease 

      - Hepatic

      - Peritoneal 

3.Infections

      - Peritoneal tuberculosis 

      - Bacterial peritonitis 

4.Hypoproteinemia

       - Nephritic syndrome

       - Protein losing enteropathy

       - Severe mal nutrition

5.Cardiac disease 

      - Congestive cardiac failure

      - Constrictive pericarditis

      - Cardiac tamponade 

6.Hepatic venous occlusion

      - Budd- Chiari syndrome

      - Veno - occlusive disease 

7.Lymphatic obstruction 

8.Pancreatitis 

9.Others      

     - Hypothyroidism

     - Vasculitis

SYMPTOMS 

1.discomfort of abdomen 

2.Shortness of breath (sob)

3.Dizziness 

4.Aneroxia

5.Pedal oedema 

SIGN 

1.Everted umbilical

2.Shifting dullness 

3.Fluid thrill

4.Puddle sign positive

D/D (5f)

1.foetus (pregnancy)

2.Fat

3.Flatus

4 Fibroid (tumor)

5.Fluid 

INVESTIGATION

1.USG 

2.CBC

3 CXR ( PA VIEW)

4.Ascites fluid tapping 

         -Glucose

         - Protein 

         - LDH

         -TC/DC

         -ADA

TREATMENT

1.general treatment

        - Low salt diet

        - Fluid<1.5 ltr 

        - 

2.Symptomatic treatment

  • If shortness if breath - fluid tapping 

3Specific treatment

      • diuretics 

        - Frusemide 40- 400 mg OD 

               Or 

        - Spirinolactone 50-150 mg OD

4.Surgery