Ascites – wikipedia gas outage


In the developed world, the most common cause is liver cirrhosis. [3] Other causes include cancer, heart failure, tuberculosis, pancreatitis, and blockage of the hepatic vein. [3] In cirrhosis, the underlying mechanism involves high blood pressure in the portal system and dysfunction of blood vessels. [3] Diagnosis is typically based on an examination together with ultrasound or a CT scan. [2] Testing the fluid can help in determining the underlying cause. [2]

Treatment often electricity pick up lines involves a low salt diet, medication such as diuretics, and draining the fluid. [2] A transjugular intrahepatic portosystemic shunt (TIPS) may be placed but is associated with complications. [2] Effects to treat the underlying cause, such as by a liver transplant may be considered. [3] Of those with cirrhosis, more than half develop ascites in the ten years following diagnosis. [3] Of those in this group who develop ascites, half will die within three years. [3] The term is from the Greek askítes meaning baglike. [4]

Routine complete blood count (CBC), basic metabolic profile, liver enzymes, and coagulation should be performed. Most experts recommend a diagnostic paracentesis be performed if the ascites is new or if the person with ascites is being admitted gas vs diesel generator to the hospital. The fluid is then reviewed for its gross appearance, protein level, albumin, and cell counts (red and white). Additional tests will be performed if indicated such as microbiological culture, Gram stain and cytopathology. [5]

The serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites. [8] A high gradient ( 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (8 mmHg, usually around 20 mmHg [10]), e.g. due to cirrhosis, while exudates are actively secreted fluid due to inflammation or malignancy. As a result, exudates are high in protein and lactate dehydrogenase and have a low pH (7.30), a low glucose level, and more white blood cells. Transudates have low protein (30 g/L), low LDH, high pH, normal glucose, and fewer than 1 white cell per 1000 mm³. Clinically, the most useful measure is the difference between ascitic and serum albumin concentrations. A difference of less than 1 g/dl (10 g/L) implies an exudate. [5]

Regardless of the cause, sequestration of fluid within the abdomen leads to additional fluid electricity jeopardy retention by the kidneys due to stimulatory effect on blood pressure hormones, notably aldosterone. The sympathetic nervous system is also activated, and renin production is increased due to decreased perfusion of the kidney. Extreme disruption of the renal blood flow can lead to hepatorenal syndrome. Other complications of ascites include spontaneous bacterial peritonitis (SBP), due to decreased antibacterial factors in the ascitic fluid such as complement.

Ascites is generally treated while an underlying cause is sought, in order gas finder app to prevent complications, relieve symptoms, and prevent further progression. In people with mild ascites, therapy is usually as an outpatient. The goal is weight loss of no more than 1.0 kg/day for people with both ascites and peripheral edema and no more than 0.5 kg/day for people with ascites alone. [11] In those with severe ascites causing a tense abdomen, hospitalization is generally necessary for paracentesis. [12] [13]

Since salt restriction is the basic concept in treatment, and aldosterone is one of the hormones that acts to increase salt retention, a medication that counteracts aldosterone should be sought. Spironolactone (or other distal-tubule diuretics such as triamterene or amiloride) is the drug of choice since they block the aldosterone receptor in the collecting tubule. This choice has been confirmed in a randomized controlled trial. [16] Diuretics electricity generation definition for ascites should be dosed once per day. [17] Generally, the starting dose is oral spironolactone 100 mg/day (max 400 mg/day).

40% of people will respond to spironolactone. [14] For nonresponders, a loop diuretic may also be added and generally, furosemide is added at a dose of 40 mg/day (max 160 mg/day), or alternatively ( bumetanide or torasemide). The ratio of 100:40 reduces risks of potassium imbalance. [17] Serum potassium level and renal function should be monitored closely while electricity bill saudi electricity company on these medications. [15]

If the person exhibits a resistance to or poor response to diuretic therapy, ultrafiltration or aquapheresis may be needed to achieve adequate control of fluid retention and congestion. The use of such mechanical methods of fluid removal can produce meaningful clinical benefits in people with diuretic resistance and may restore responsiveness to conventional doses of diuretics. [20] [21] Paracentesis [ edit ]

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• ^ Adams KF, Lindenfeld J, Arnold JM, Baker DW, Barnard DH, Baughman KL, Boehmer JP, Deedwania P, Dunbar SB, Elkayam U, Gheorghiade M, Howlett JG, Konstam MA, Kronenberg MW, Massie BM, Mehra MR, Miller AB, Moser DK, Patterson JH, Rodeheffer RJ, Sackner-Bernstein J, Silver MA, Starling RC, Stevenson LW, Wagoner LE (2006). Heart Failure Society of America (HFSA) 2006 Comprehensive Heart Failure Practice Guideline. J Cardiac Failure. 12 (1): e1–e122. doi: 10.1016/j.cardfail.2005.11.005. PMID 16500560.