Ascites
It is an accumulation of excess fluid at least 500mL in peritoneal cavity. There are several causes of ascites. Portal hypertension (sinusoidal hypertension) related causes include Cirrhosis, Acute hepatitis, Liver malignancy and right sided heart failure. Among non portal hypertension related causes Peritonitis (eg: tuberculosis), Pancreatitis, hypoalbuminemia, Meig's syndrome (ovarian tumor), Vasculitis are common. In ascites patient presents with signs of 1. Abdominal distension 2. Fluid thrill and shifting dullness to percussions. How will you manage this patient? Firstly restricting water and sodium intake in diet to stop further fluid leakage. Diuretics such as Spironolactone is drug of choice. In cases of refractory ascites i.e. diuretic resistant ascites, the first line of treatment is Large volume paracentesis. 3-5L per day of fluid is removed or until dry. Trans-jugular intra-hepatic portosystemic shunt (TIPSS) is also used for refractory cases. Image from alfapump.com