Stuff I’m Learning: Ascites

white-coat:

Ascites is basically the accumulation of fluid in your abdomen. A lot of things can lead to ascites, but the main cause is cirrhosis, which is essentially when you drink so much booze that it scars your liver. So with that cause in mind, ascites is like alcohol knocking you up with a water baby because you’re a total hooch goblin. It looks like this:

Like I said: pregnant with a water-baby. How does this happen? Your liver is the master biochemical organ of the body. It filters everything you take in and absorb through your intestines. What happens in cirrhosis is all that alcohol wreaks havoc on your liver, causing the cells to explode. As part of the healing process, you body forms scar tissue with collagen to try and hold it all together; that’s the amazing thing about the healing process. What’s not amazing is when it’s in your liver where blood is supposed to freely flow through on it’s way back to your heart. So what happens in ascites is that all this blood flow gets backed up, creating higher pressure going through an organ that’s had holes punched in it. As a result, the liver literally weeps a fluid called ‘transudate,’ which is your plasma without the red blood cells and proteins in it. This fluid trickles down into your abdomen and voila! Ascites.

As you might notice, this bears a lot of resemblance to the kids you see in Africa with Kwashiorkor. In Kwashiorkor we have abdominal swelling because the kids are protein deficient, can’t make blood proteins like Albumin and therefore lack the presence of protein in the blood to “attract” fluid to stay in the blood stream (this is called oncotic pressure).

Back to our hooch goblin with ascites! Not only does this guy have issues with his liver leaking fluid, but because it’s shot to hell. He’s not making Albumin, so he also has Kwashiorkor going on at the same time, kind of like a hit combo to make his life miserable.

So how do we treat this? Well in this case the guy is going to need a liver transplant, but since he’s an alcoholic he won’t get one and we try to drain the fluid as best we can. We limit the amount of salt in his diet, reduce his fluid intake for a bit, put him on diuretics to increase the fluid loss and in cases of Kwashiorkor, we supplement the Albumin. If there’s a lot of fluid in the abdomen, it’s on to paracentesis which in involves a very large needle to drain it.

(via white-coat-deactivated20111012-)

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  1. cranquis said: Bwa-haha! “Alcohol knocking you up with a water baby”!! Classic!
  2. alexandralynnee said: I am studying for the NCLEX (for those of you who don’t know, the nursing “boards”) and your posts are like little flashcards for me to review stuff! Thanks!