๐Ÿ’ง Chapter 418: Ascites

Nelson Textbook of Pediatrics 22nd Edition โ€” Ascites is the pathologic accumulation of fluid in the peritoneal cavity. Causes: portal hypertension (cirrhosis, EHPVO), nephrotic syndrome, chylous ascites, infection (SBP, TB), malignancy, pancreatitis, heart failure. Evaluation: serum-ascites albumin gradient (SAAG), paracentesis (cell count, culture, protein, triglycerides). Management: sodium restriction, diuretics (spironolactone, furosemide), large volume paracentesis, TIPS, liver transplant.

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๐Ÿ“‹ 30 Clinical Scenarios โ€” Ascites

๐Ÿ“‡ Highโ€‘Yield Review Cards (Ascites)

๐Ÿฉบ Clinical Presentations: Ascites

Select a presentation for diagnostic clues and management.

๐Ÿ“‹ Stepwise Evaluation & Management of Ascites

๐Ÿ”‘ Key Principles โ€” Ascites (Nelson Ch.418)
โ€ข Serum-Ascites Albumin Gradient (SAAG): SAAG = serum albumin - ascitic fluid albumin. High SAAG (>1.1 g/dL) โ†’ portal hypertension (cirrhosis, EHPVO, Budd-Chiari). Low SAAG (<1.1 g/dL) โ†’ non-portal causes (nephrotic syndrome, TB, malignancy, pancreatitis, chylous ascites).
โ€ข First-line treatment for cirrhotic ascites: Sodium restriction (<2 g/day), spironolactone (1-3 mg/kg/day), furosemide (0.5-1 mg/kg/day).
โ€ข Spontaneous bacterial peritonitis (SBP): Ascitic fluid PMN โ‰ฅ250 cells/ฮผL. Treat with IV cefotaxime/ceftriaxone.
โ€ข Chylous ascites: Milky fluid, triglyceride >200 mg/dL. Treat low-fat diet + MCT oil, octreotide.

    โšก Reflex Prompts โ€” Ascites Clinical Decisions

    ๐Ÿ“– Ascites โ€” Core Summary (Nelson Ch.418)