ASCITES : DEFINATION, CAUSES, TAYPS, COMPLICATION, TREATMENT ،، استسقاء البطن ،، الاستسقاء
DEFINITION :-
It is pathological collection of fluid in the peritoneal cavity.
Ascites is the most common complication of cirrhosis. It is a poor prognostic factor.
Portal hypertension, renin angiotensin aldosterone pathway causing renal sodium retention, increased hydrostatic pressure in hepatic sinusoids and splanchnic vessels .
CAUSE :-
- In metastatic malignancy ascites develops due to live secondaries.
- peritoneal carcinomatosis which secretes protein rich fluid and lymph.
- Leakage of pancreatic juice, bile, lymph also causes specific ascites.
TAYPES :-
- Mild — Up to 150 ml amount required to demon-strate radiologically
- Moderate — 1500-2000 ml causes clinical dullness in flanks.
- Severe — > 2000 ml.
CLASSIFICATION :-
1-Transudate (Protein < 2.5 gm/ dl).
•CCF—Commonest (SAAG > 1.1).
•Hypoproteinaemia.
•Anaemia.
•Beri-beri.
•Nephrotic syndrome.
•Portal hypertension.
•Polyserositis.
2- Exudate (Protein > 2.5 gm/dl) (SAAG < 1.1).
•Peritoneal diseases.
•Tuberculosis.
•Bacterial, fungal and parasitic infection.
•Neoplasm.
•Collagen disorder.
•Eosinophilic gastroenteritis.
•Granulomatous peritonitis.
COMPLICATIONS :-
- • Respiratory embarrassment.
- • Umbilical hernia with erosion, ulceration and leak.
- • Spontaneous bacterial peritonitis.
TREATMENT :-
1- The cause is treated.
2- Therapeutic tap—It should be slow and gradual or staged
tapping. Up to 5 litres can be tapped in 90 minutes.
3-Ascitic shunt surgeries.
4-Spironolactone, salt restriction.
5-Salt (sodium) restriction in diet is important. It is assessed by measuring 24 hour urinary sodium excretion. If it is more than 78 mmol/day patient will loose weight with salt restricted dite.
6- Spironolactone 100 mg/day and frusemide 40 mg/day
promotes natriuresis and reduces the ascites. It is very useful after paracentesis to prevent re-accumulation of fluid.
7- TIPSS.
8- Liver transplantation.
THE END
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