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Ascites, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Pathologic accumulation of serous fluid in the peritoneal cavity

  • Portal hypertension (>12 mm Hg) starts fluid retention.

  • Avid sodium retention state

  • Retained sodium and water increas...

Diagnosis

Signs and Symptoms

  • Abdominal distention, discomfort

  • Weight gain; sometimes weight loss

  • Dyspnea

  • Orthopnea

  • Edema

  • Abdominal hernias

  • Muscle wasting

  • Shifting dullness, flank fullness, fluid wave, puddle ...

Treatment

Pre-Hospital

Symptomatic hypotension: 
  • Airway, breathing, circulation (ABCs), IV 0.9 NS

Initial Stabilization/Therapy

Sudden increase in abdominal girth, pain, or fever requires urgent evaluatio...

Follow-Up

Disposition

Admission Criteria

  • Fulminant liver failure

  • Hepatic encephalopathy

  • SBP

  • Hepatorenal syndrome

  • GI bleeding

  • Tense ascites not responding to ED treatment

Discharge Criteria

Patients responding ...

Pearls and Pitfalls

  • New cases need full workup and GI consultation for management.

  • SBP symptoms are frequently vague.

  • Must have a high suspicion and low threshold for paracentesis when considering SBP

  • Be...

Additional Reading

  • Feldman  M. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: WB Saunders; 2010.

  • Runyon  BA; AASLD Practice Guidelines Committee. Management o...

Codes

ICD9

  • 789.5 Ascites

  • 789.51 Malignant ascites

  • 789.59 Other ascites

ICD10

  • R18 Ascites

  • R18.0 Malignant ascites

  • R18.8 Other ascites

SNOMED

  • 389026000 Ascites (disorder)

  • 307311001 Infected ascites (disorder)

  • 2360...

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