Ascites

Answer Explanation:

• The correct answer is ‘Aspiration of ascitic fluid is required to differentiate between transudate and exudate’. This is because the nature of the fluid (whether it’s a transudate or an exudate) can only be determined by analysing the fluid’s protein content and cell count, which requires aspiration.

Incorrect Options Explanation:

• ‘A fluid thrill indicates cardiac involvement’ – This is incorrect. A fluid thrill is a physical examination finding in ascites, but it does not specifically indicate cardiac involvement.
• ‘Dietary protein restriction is useful in the management of ascites’ – This is incorrect. Dietary protein restriction is not recommended in ascites, as it can lead to protein malnutrition.
• ‘Bendroflumethiazide is the diuretic of choice for ascites’ – This is incorrect. The diuretics of choice for ascites are usually spironolactone and furosemide.
• ‘A maximum of 1 L of fluid should be drawn off during ascitic paracentesis’ – This is incorrect. Large-volume paracentesis can safely remove more than 1 L of fluid, although it may require albumin replacement to prevent post-paracentesis circulatory dysfunction.

Overview of Ascites:

• Ascites is the accumulation of fluid in the peritoneal cavity, commonly caused by liver disease, particularly cirrhosis.
• Other causes include heart failure, malignancy, tuberculosis, pancreatitis, and nephrotic syndrome.
• Clinical features include abdominal distension, shifting dullness, and a fluid thrill.
• Management involves treating the underlying cause, sodium restriction, diuretics (spironolactone and furosemide), and paracentesis if necessary.
• Complications of ascites include spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic hydrothorax.

Answer Explanation:

• Cushing’s syndrome is the correct answer because it is not known to cause ascites. Ascites is the accumulation of fluid in the peritoneal cavity, commonly caused by liver disease, but can be caused by a number of other conditions.
• Peritoneal carcinomatosis, nephrotic syndrome, Budd-Chiari syndrome, and ovarian fibroma are all conditions that can lead to ascites. Peritoneal carcinomatosis causes ascites due to the spread of cancer cells to the peritoneum. Nephrotic syndrome can cause ascites due to severe protein loss in the urine leading to low albumin levels. Budd-Chiari syndrome can cause ascites due to obstruction of the hepatic veins. Ovarian fibroma can cause ascites due to Meigs’ syndrome.
• Cushing’s syndrome, on the other hand, is characterized by high levels of cortisol in the body, leading to symptoms such as weight gain, purple or pink stretch marks, and thinning skin. It does not typically cause ascites.

Overview of Ascites:

• Ascites is the accumulation of fluid in the peritoneal cavity, which is the space between the abdominal wall and the organs.
• It is most commonly caused by liver disease, particularly cirrhosis. Other causes include peritoneal carcinomatosis, nephrotic syndrome, Budd-Chiari syndrome, and ovarian fibroma.
• Symptoms can include abdominal distension, discomfort, and shortness of breath. In severe cases, it can lead to complications such as spontaneous bacterial peritonitis and hepatorenal syndrome.
• Diagnosis is usually based on clinical examination and confirmed by ultrasound or CT scan. Paracentesis may also be performed to analyze the ascitic fluid.
• Treatment typically involves addressing the underlying cause, dietary modifications, diuretics, and in some cases, therapeutic paracentesis or other surgical interventions.