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Large volume abdominal ascites. The use of ultrasound has become the standard of care when preparing a patient for paracentesis. Confirmation of an ascitic effusion reduces the risks associated with a dry or blind tap of the abdomen.
Ascites (/ ə ˈ s aɪ t i z /; [5] Greek: ἀσκός, romanized: askos, meaning "bag" or "sac" [6]) is the abnormal build-up of fluid in the abdomen. [1] Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. [4]
The concomitant infusion of albumin can avert the circulatory dysfunction that occurs after large-volume paracentesis and may prevent HRS. [20] Conversely, in individuals with very tense ascites, it has been hypothesized that removal of ascitic fluid may improve kidney function if it decreases the pressure on the renal veins. [21]
The serum-ascites albumin gradient (SAAG) is the most useful index for evaluating peritoneal fluid and can help distinguish ascites caused by portal hypertension (cirrhosis, portal vein thrombosis, Budd-Chiari syndrome, etc.) from other causes of ascites. SAAG is calculated by subtracting the albumin measure of ascitic fluid from the serum value.
It is specifically an infection of the ascitic fluid – an increased volume of peritoneal fluid. [2] Ascites is most commonly a complication of cirrhosis of the liver. [1] It can also occur in patients with nephrotic syndrome. [3] [4] SBP has a high mortality rate. [5]
The management of ascites needs to be gradual to avoid sudden changes in systemic volume status, which can precipitate hepatic encephalopathy, kidney failure, and death. The management includes salt restriction in diet, diuretics to urinate excess salt and water ( furosemide , spironolactone ), paracentesis to manually remove the ascitic fluid ...
It is also used to prevent iatrogenic hypoalbuminemia after therapeutic plasmapheresis if volume plasma exchange is greater than 20 milliliters per kilogram in one session or over one week across multiple sessions and after large volume (>5 liter) paracentesis in ascites. [7]
The serum-ascites albumin gradient or gap (SAAG) is a calculation used in medicine to help determine the cause of ascites. [1] The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate. [2] The formula is as follows: SAAG = (serum albumin) − (albumin level of ascitic fluid).