Q: Who is the specialist I should consult when I notice ascites?
A: Ascites is treated by a gastroenterologist who will examine the patient first, and may then redirect the patient to another specialist depending on the cause of the Ascites.
Q: What are the tests that should be done on the ascitic fluid?
A: The most important tests include:
- The W.B.C or the white blood cell count to determine the presence of infection.
- An increase in the count with predominant neutrophils is suggestive of bacterial infection and antibiotics should be started.
- An increase in lymphocytes suggests tuberculosis or malignancy in the patient.
- Albumin concentration to calculate the SAAG and determine the type of ascites.
- Culture to isolate the causative organisms in case of infection.
- Total protein concentration to determine patients who are at high risk for developing spontaneous bacterial peritonitis.
- Amylase activity, which is elevated in pancreatic ascites and gut perforation.
- Gram Stain can be helpful in gut perforation when multiple types of bacteria are seen.
- Cytology of ascitic fluid helps in detecting ascites due to cancer when the peritoneum is involved.
Q: How do I manage a low salt diet?
A: Try to limit your salt intake to 1 teaspoon a day or less than 2000mg a day. Avoid processed and canned foods, salted nuts, pickles, fried chips among others.Prepare a diet chart and make a list of food to be avoided and follow it strictly.
Q: How can food taste good without salt?
A: Try adding lemon juice, herbs and spice mixes to enhance the taste of food. Avoid salt substitutes as they have too much potassium.
Q: What about sugar and fats?
A: There is no problem if you have it in moderation. But if you have diabetes or hypertension, you need to control this and be more careful.
Q: With so much fluid, donít I need to restrict water?
A: It is the sodium restriction that is important, fluid restriction in all patients with ascites is inappropriate. Only in severe hyponatremia when the sodium level drops to 120mEq/l in a patient with ascites, fluid restriction is indicated.
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Dr. Vidya Viswanath. "Ascites - Frequently Asked Questions / FAQs ". Medindia. Feb 01, 2023. <https://www.medindia.net/patients/patientinfo/ascites-faq.htm>.
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