Ascites resident survival guide: Difference between revisions
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❑ General appearance:<br> | ❑ General appearance:<br> | ||
:❑ BMI(weight loss/weight gain) | :❑ BMI(weight loss/weight gain) | ||
:❑ Peripheral edema | |||
:❑ [[Jaundice]], muscle wasting, [[gynecomastia]], and leukonychia, lymphadenopathy | |||
:❑ Peripheral [[edema]] | |||
:❑ [[JVD]] | :❑ [[JVD]] | ||
❑ Heart: <br> | ❑ Heart: <br> | ||
:❑ Murmur | :❑ Murmur | ||
:❑ Carotid and peripheral pulses | :❑ Carotid and peripheral pulses | ||
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❑ Abdomen:<br> | ❑ Abdomen:<br> | ||
:❑ [[Hepatomegaly]] | :❑ [[Hepatomegaly]] | ||
:❑ pulsatile liver and/or [[ascites]] (volume overload) <br> | :❑ pulsatile liver and/or [[ascites]] (volume overload) <br> | ||
:❑ Flank dullness, shifting dullness, a fluid wave, evidence of pleural effusions | |||
:❑ | :❑ Stigmata of [[cirrhosis]] (spider angioma, palmar erythema, and abdominal wall collaterals) | ||
:❑ Umbilical nodule that is not bowel or omentum | |||
</div>}} | </div>}} | ||
{{familytree | | | | | | | | C01 |C01=A01}} | {{familytree | | | | | | | | C01 |C01=A01}} |
Revision as of 16:59, 11 March 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]
Ascites resident survival guide Microchapters |
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Overview |
Classification/Causes |
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:[1]
Causes | |||||||||||||||||||||||||||||||||
Portal hypertension: ❑ Cirrhosis | Peritoneal disease: ❑ Malignant ascites | Other etiologies: ❑ Chylous ascites | |||||||||||||||||||||||||||||||
Complete Diagnostic Approach
A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.[1]
History and symptoms: ❑ Hints for etiology (i.e. cirrhosis, malignancy)? ❑ Abdominal distension/abdominal discomfort? ❑ Duration and onset of illness/ symptoms? ❑ Severity and triggers? ❑ Weight loss/weight gain/early satiety? ❑ Presence of peripheral edema, anasarca? ❑ Problems with breathing at night/ sleep? ❑ Fever, abdominal tenderness, and altered mental status? ❑ Diarrhea and steatorrhea, malnutrition, nausea, enlarged lymph nodes ❑ Medical history
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Physical examination: ❑ Vital signs:
❑ General appearance:
❑ Heart:
❑ Lungs:
❑ Abdomen:
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Treatment
shown
hidden
Do's
Dont's
References
- ↑ 1.0 1.1 1.2 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.