Sammie Quon presented this year’s first intern report: a patient who presented with ascites and lower extremity edema with a history of heavy drinking, found to have alcoholic cirrhosis.
The cause of ascites can be classified into portal hypertension (Cirrhosis, Budd-chiari, heart failure, constrictive pericarditis), hypoalbuminemia (nephrotic syndrome, severe malnutrition, protein losing enteropathy) and peritoneal disease (malignancy, infection).
Ascites fluid analysis can help guide the diagnosis and should always include cell count, gram stain, protein and albumin. The serum to ascites albumin gradient (SAAG) and ascites protein can help differentiate between the different causes.
*Remember that cirrhotic patients with low ascites protein levels are at increased risk for infection, thus antibiotic prophylaxis for SBP should be started in patients with protein<1.5 AND one of the following: Cr≥1.2, BUN≥25, Na ≤130, Childs≥9, or Tbili≥3. Prophylaxis should also be given to patients with GI bleed and prior history of SBP.
*Albumin should be given to patients with diagnosed SBP with one of the following: Cr>1, BUN>30 or Tbili>4. This has been shown to decrease mortality and renal impairment.
Cirrhosis Handout for a basic review of complications and management of cirrhosis.
Thank you Sammie for presenting a great case and teaching us about cirrhosis!