Ascites resident survival guide: Difference between revisions
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{{familytree | |,|-|-|v|-|-|-|^|v|-|-|-|.| | | }} | {{familytree | |,|-|-|v|-|-|-|^|v|-|-|-|.| | | }} | ||
{{familytree | B01 | B02 | | | B03 | | B02 | | |B01=<div style="text-align: left;"><b>Portal hypertension:</b> | {{familytree | B01 | B02 | | | B03 | | B02 | | |B01=<div style="text-align: left;"><b>Portal hypertension:</b> | ||
❑ [[Cirrhosis]] | ❑ [[Cirrhosis]] | ||
❑ [[Alcoholic hepatitis]] | ❑ [[Alcoholic hepatitis]] | ||
❑ [[Acute liver failure]] | ❑ [[Acute liver failure]] | ||
❑ Hepatic veno-occlusive disease (eg, Budd-Chiari syndrome) | ❑ Hepatic veno-occlusive disease (eg, Budd-Chiari syndrome) | ||
❑ [[Heart failure]] | ❑ [[Heart failure]] | ||
❑ [[Constrictive pericarditis]] | ❑ [[Constrictive pericarditis]] | ||
❑ Hemodialysis-associated [[ascites]] (nephrogenic ascites)</div> | ❑ Hemodialysis-associated [[ascites]] (nephrogenic ascites)</div> | ||
|B02=<div style="text-align: left;"><b>Hypoalbuminemia:</b> | |B02=<div style="text-align: left;"><b>Hypoalbuminemia:</b> | ||
❑ [[Nephrotic syndrome]] | ❑ [[Nephrotic syndrome]] | ||
❑ Protein-losing enteropathy | ❑ Protein-losing enteropathy | ||
❑ Severe [[malnutrition]]</div>| | ❑ Severe [[malnutrition]]</div>| | ||
B03=<div style="text-align: left;"><b>Peritoneal disease:</b> | B03=<div style="text-align: left;"><b>Peritoneal disease:</b> | ||
❑ Malignant [[ascites]] | ❑ Malignant [[ascites]] | ||
❑ Infectious [[peritonitis]] | ❑ Infectious [[peritonitis]] | ||
❑ Eosinophilic [[gastroenteritis]] | ❑ Eosinophilic [[gastroenteritis]] | ||
❑ Starch granulomatous [[peritonitis]] | ❑ Starch granulomatous [[peritonitis]] | ||
❑ Peritoneal dialysis</div> | ❑ Peritoneal dialysis</div> | ||
|B04=<div style="text-align: left;"><b>Other etiologies:</b> | |B04=<div style="text-align: left;"><b>Other etiologies:</b> | ||
❑ Chylous ascites | ❑ Chylous ascites | ||
❑ Pancreatic ascites (eg, from a disrupted pancreatic duct) | ❑ Pancreatic ascites (eg, from a disrupted pancreatic duct) | ||
❑ [[Myxedema]] | |||
❑ Myxedema | |||
❑ Hemoperitoneum</div>}} | ❑ Hemoperitoneum</div>}} | ||
{{familytree/end}} | |||
==FIRE: Focused Initial Rapid Evaluation== | ==FIRE: Focused Initial Rapid Evaluation== | ||
Revision as of 15:27, 11 March 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]
| Ascites resident survival guide Microchapters |
|---|
| Overview |
| Classification/Causes |
| FIRE |
| Diagnosis |
| Treatment |
| Do's |
| Dont's |
Overview
Accumulation of fluid within the peritoneal cavity results in ascites. Most important for a successful treatment of ascites is an accurate diagnosis of its cause. Most common causes are portal hypertension, malignancy and heart failure. The diagnosis is made with a combination of physical examination and abdominal imaging. The next step is typically a paracentesis to evaluate the ascitic fluid for causes.[1]
Classification/Causes
Ascites can be classified based on the underlying causes. Common causes are:
| Causes | |||||||||||||||||||||||||||||||||
Portal hypertension:
❑ Cirrhosis ❑ Alcoholic hepatitis ❑ Acute liver failure ❑ Hepatic veno-occlusive disease (eg, Budd-Chiari syndrome) ❑ Heart failure ❑ Constrictive pericarditis ❑ Hemodialysis-associated ascites (nephrogenic ascites) | Hypoalbuminemia:
❑ Nephrotic syndrome ❑ Protein-losing enteropathy ❑ Severe malnutrition | Peritoneal disease:
❑ Malignant ascites ❑ Infectious peritonitis ❑ Eosinophilic gastroenteritis ❑ Starch granulomatous peritonitis ❑ Peritoneal dialysis | Hypoalbuminemia:
❑ Nephrotic syndrome ❑ Protein-losing enteropathy ❑ Severe malnutrition | ||||||||||||||||||||||||||||||
FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
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| D01 | D02 | D03 | |||||||||||||||||||||||||||||||
| E01 | E02 | E03 | |||||||||||||||||||||||||||||||
| F01 | F02 | ||||||||||||||||||||||||||||||||
Complete Diagnostic Approach
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| C01 | |||||||||||||||||||||||||||||||||
| D01 | D02 | D03 | |||||||||||||||||||||||||||||||
| E01 | E02 | E03 | |||||||||||||||||||||||||||||||
| F01 | F02 | ||||||||||||||||||||||||||||||||
Treatment
shown
hidden
Do's
Dont's
References
- ↑ Runyon BA, AASLD (2013). "Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012". Hepatology. 57 (4): 1651–3. doi:10.1002/hep.26359. PMID 23463403.