Assessment and Management of the Patient with Ascites - Flowchart

Assessment and Management of the Patient with Ascites - Flowchart

Assessment and Management of the Patient with Ascites - Flowchart Assessment and Management of the Patient with Ascites Assessment and Management of the Patient with Ascites

Flowchart

Ascites (confirm by ultrasonography)

Ascites (confirm by ultrasonography)

Ascites (confirm by ultrasonography)

End

End

End

Known cirrhosis?

Known cirrhosis?

Known cirrhosis?

Yes

Yes

Yes

No

No

No

Diagnostic aspiration (Box 24.1) to exclude spontaneous bacterial peritonitis (Table 24.1)

Diagnostic aspiration (Box 24.1) to exclude spontaneous bacterial peritonitis (Table 24.1)

Diagnostic aspiration (Box 24.1) to exclude spontaneous bacterial peritonitis (Table 24.1)

Box 24.1 Table 24.1

New-onset ascites?
Abdominal pain?
Signs of infection?
Encephalopathy?

New-onset ascites?
Abdominal pain?
Signs of infection?
Encephalopathy?

New-onset ascites?
Abdominal pain?
Signs of infection?
Encephalopathy?

Yes

Yes

Yes

No

No

No

Diuretic therapy (Appendix 24.1)

Diuretic therapy (Appendix 24.1)

Diuretic therapy (Appendix 24.1)

Appendix 24.1

Volume of ascites?

Volume of ascites?

Volume of ascites?

Small/moderate

Small/moderate

Small/moderate

Large/tense

Large/tense

Large/tense

Paracentesis diuretic therapy

Paracentesis diuretic therapy

Paracentesis diuretic therapy

Coagulopathy?

Coagulopathy?

Coagulopathy?

Yes

Yes

Yes

No

No

No

Diuretic therapy
Treat cause

Diuretic therapy
Treat cause

Diuretic therapy
Treat cause

Diagnostic aspiration (Box 24.1, Table 24.1)

Diagnostic aspiration (Box 24.1, Table 24.1)

Diagnostic aspiration (Box 24.1, Table 24.1)

Box 24.1 Table 24.1

Known congestive heart failure or pericardial constriction?

Known congestive heart failure or pericardial constriction?

Known congestive heart failure or pericardial constriction?

Yes

Yes

Yes

No

No

No

Treat cause (Table 24.2)

Treat cause (Table 24.2)

Treat cause (Table 24.2)