25.1.10
Ascites (malignant and Non-Malignant)
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 25, Palliative Care.
Clinical Description
Common causes (see relevant chapter for details)
Signs and Symptoms
Malignant: cancers - liver, KS, cervical ovarian cancer
Non-malignant: Complication from abdominal infection e.g. tuberculosis, cardiac failure, renal failure
Investigations
- Full blood count
- Liver function
- Urea, creatinine and electrolytes
- Ascitic tap for LDH, Protein, Microscopy, gram stain, ZN stain, geneXpert and cytology
Non-pharmacological
- comfortable positioning, counselling the patient and family, salt reduction
Pharmacological
- Furosemide 40 to 80 mg 24 hourly, can be combined with Spironolactone 25 to 100mg 24 hourly
Complications and Referral Criteria
- Where necessary patients can be referred for therapeutic tapping although this provides short term relief only, note potential risk of infection, perforation, continuous leakage of fluid, induction of hypovolemic shock from repeated tapping
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