🌹بسم الله الرحمن الرحيم🌹
📌 ASCITES:
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 ascites. 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.
💉Types:
♦ Mild — Up to 150 ml amount required to demon-
strate radiologically
♦ Moderate — 1500-2000 ml causes clinical dullness in
fl anks.
♦ Severe — > 2000 ml.
💉Classification :
♦ Transudate (Protein < 2.5 gm/ dl).
•CCF—Commonest (SAAG > 1.1).
•Hypoproteinaemia.
•Anaemia.
•Beri-beri.
•Nephrotic syndrome.
•Portal hypertension.
•Polyserositis.
♦ 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 of ascites :
• Respiratory embarrassment.
• Umbilical hernia with erosion, ulceration and leak.
• Spontaneous bacterial peritonitis.
📌 Treatment of ascites:
♦ The cause is treated.
♦ Therapeutic tap—It should be slow and gradual or staged
tapping. Up to 5 litres can be tapped in 90 minutes.
♦ Ascitic shunt surgeries.
♦ Spironolactone, salt restriction.
♦ 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.
♦ 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.
♦ TIPSS.
♦ Liver transplantation.
♧ OCCLUSIVE CEREBROVASCULAR DISEASE:
» Sudden onset of weakness and numbness of an
extremity or the face, aphasia, dysarthria, or uni-
lateral blindness (amaurosis fugax).
» Bruit heard loudest in the mid neck.
♧ ACUTE ARTERIAL OCCLUSION OF A LIMB:
» Sudden pain in an extremity with absent extrem-
ity pulses.
» Usually some neurologic dysfunction with numb-
ness, weakness, or complete paralysis.
» Loss of light touch sensation requires revascular-
ization within 3 hours for limb viability.
♧ OCCLUSIVE DISEASE: TIBIAL & PEDAL
ARTERIES:
» Severe pain of the forefoot that is relieved by
dependency.
» Pain or numbness of the foot with walking.
» Ulceration or gangrene of the foot or toes.
» Pallor when the foot is elevated.
♧ OCCLUSIVE DISEASE: FEMORAL
& POPLITEAL ARTERIES:
🛑 Cramping pain or tiredness in the calf with
exercise.
» Reduced popliteal and pedal pulses.
» Foot pain at rest, relieved by dependency.
» Foot gangrene or ischemic ulcers.
🌹عافاكم الله من كل شر🌹
📌 ASCITES:
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 ascites. 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.
💉Types:
♦ Mild — Up to 150 ml amount required to demon-
strate radiologically
♦ Moderate — 1500-2000 ml causes clinical dullness in
fl anks.
♦ Severe — > 2000 ml.
💉Classification :
♦ Transudate (Protein < 2.5 gm/ dl).
•CCF—Commonest (SAAG > 1.1).
•Hypoproteinaemia.
•Anaemia.
•Beri-beri.
•Nephrotic syndrome.
•Portal hypertension.
•Polyserositis.
♦ 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 of ascites :
• Respiratory embarrassment.
• Umbilical hernia with erosion, ulceration and leak.
• Spontaneous bacterial peritonitis.
📌 Treatment of ascites:
♦ The cause is treated.
♦ Therapeutic tap—It should be slow and gradual or staged
tapping. Up to 5 litres can be tapped in 90 minutes.
♦ Ascitic shunt surgeries.
♦ Spironolactone, salt restriction.
♦ 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.
♦ 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.
♦ TIPSS.
♦ Liver transplantation.
♧ OCCLUSIVE CEREBROVASCULAR DISEASE:
» Sudden onset of weakness and numbness of an
extremity or the face, aphasia, dysarthria, or uni-
lateral blindness (amaurosis fugax).
» Bruit heard loudest in the mid neck.
♧ ACUTE ARTERIAL OCCLUSION OF A LIMB:
» Sudden pain in an extremity with absent extrem-
ity pulses.
» Usually some neurologic dysfunction with numb-
ness, weakness, or complete paralysis.
» Loss of light touch sensation requires revascular-
ization within 3 hours for limb viability.
♧ OCCLUSIVE DISEASE: TIBIAL & PEDAL
ARTERIES:
» Severe pain of the forefoot that is relieved by
dependency.
» Pain or numbness of the foot with walking.
» Ulceration or gangrene of the foot or toes.
» Pallor when the foot is elevated.
♧ OCCLUSIVE DISEASE: FEMORAL
& POPLITEAL ARTERIES:
🛑 Cramping pain or tiredness in the calf with
exercise.
» Reduced popliteal and pedal pulses.
» Foot pain at rest, relieved by dependency.
» Foot gangrene or ischemic ulcers.
🌹عافاكم الله من كل شر🌹