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2 results

  • 3.3.3 - Ascites

  • from Section 3.3 - Acute Liver Failure
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 164-167

  • Summary

    Key Learning Points

    1. 1. The most common cause of ascites in the UK is hepatic cirrhosis.

    2. 2. Diagnosis of the underlying aetiology is key for management and dependent on a robust history and examination, with appropriate tests on serum and paracentesis samples.

    3. 3. Whilst certain routine tests should be performed on all paracentesis samples, more specialist tests should be ordered, dependent on clinical findings.

    4. 4. Clinical suspicion of spontaneous bacterial peritonitis requires rapid diagnosis and management to prevent deterioration.

    5. 5. Ascites secondary to portal hypertension that is resistant to medical therapy is an indication for liver transplantation.

  • 5.4.1 - Abdominal Paracentesis

  • from Section 5.4 - Practical Gastrointestinal System
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 611-613

  • Summary

    Key Learning Points

    1. 1. Abdominal drains should be inserted under ultrasound guidance.

    2. 2. Use the ‘Z-track’ technique to minimise complications.

    3. 3. Pay attention to volume replacement, particularly in the critically unwell patient.

    4. 4. Antibiotic administration should not be delayed in cases of suspected spontaneous bacterial peritonitis.

    5. 5. Differentiating transudative from exudative ascites is achieved by calculating the serum–ascites albumin gradient.