Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- abdominal pain or tenderness
- signs of ascites
- fever
- nausea/vomiting
- diarrhea
- altered mental status
- gastrointestinal bleed
Outros fatores diagnósticos
- hypothermia
- hypotension
- tachycardia
Fatores de risco
- decompensated hepatic state (usually cirrhosis)
- low ascitic protein/complement
- gastrointestinal bleeding
- endoscopic sclerotherapy for esophageal varices
- ascites due to malignancy, renal insufficiency, or congestive heart failure
- extraintestinal infection
- invasive procedures
- use of proton-pump inhibitors (PPIs)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
- serum creatinine
- LFT
- prothrombin time/INR
- blood cultures
- ascitic fluid appearance
- ascitic fluid absolute neutrophil count (ANC)
- ascitic fluid culture
- ascitic fluid protein, glucose, lactate dehydrogenase (LDH), pH
Investigações a serem consideradas
- serum-ascites albumin gradient (SAAG)
- ascitic fluid carcinoembryonic antigen (CEA)
- ascitic fluid alkaline phosphatase
- ascitic fluid AFB stain and culture, fungal culture, microscopy for ova/parasites
- ascitic fluid lactoferrin
- CT scan abdomen
Novos exames
- highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid (Periscreen)
- bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid
Algoritmo de tratamento
community-acquired infection with low risk for resistant species
nosocomial infection, septic shock, high risk for MDR organisms
Colaboradores
Autores
Brian Chinnock, MD
Associate Professor of Emergency Medicine
UCSF Fresno Medical Education Program
Fresno
CA
Declarações
BC is an author of references cited in this topic.
Revisores
Ke-Qin Hu, MD
Director, Hepatology Services, H.H. Chao Comprehensive Digestive Disease Center
Professor of Medicine
School of Medicine
University of California, Irvine
Irvine
CA
Declarações
KQH declares that he has no competing interests.
Andrea De Gottardi, MD, PhD
Visiting Hepatologist
Hepatic Hemodynamic Laboratory
Liver Unit
Hospital Clinic
Barcelona
Spain
Declarações
ADG declares that he has no competing interests.
Referências
Principais artigos
Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.Texto completo Resumo
European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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