Persistent ascites

Hepato-renal syndrome rapid progressive (type I) with rising serum creatinine levels, or non-progressive and less severe (type II) impairment of renal function, often consequent on bacterial peritonitis, with persistent ascites responds to vasoconstrictor treatment, typically with terlipressin through constriction of splanchnic vessels and improved renal perfusion. Withdrawal of treatment does not seem to lead inevitably to recurrence. Haemodialysis may also stabilise patients. 

Gnoth C, Halbe E, Freundl G. Persistent ascites after ovarian hyperstimulation syndrome and administration of mifepristone (RU 486) for the termination of pregnancy. Arch Gynecol Obstet 2003 268 65-8. 

The child s subsequent course was one of gradual hepatic deterioration.At age 3 years, he was noted to have ascites (intra-abdominal fluid accumulation). This progressed slowly until the age of 6 years, when severe ascites and peripheral edema necessitated the initiation of spironolactone (a potassium-sparing diuretic). Several admissions to the hospital were required over the next 6 years for ascites with scrotal edema. Serum albumin values were persistently low, less than 2.0 g/dL. During this time, the patient also had two episodes of primary peritonitis (intraperitoneal infection) and one episode of a-streptococcal sepsis. 

Liver biopsies performed in patients with chronic HBV infection are classified as chronic persistent hepatitis, chronic active hepatitis, and cirrhosis. Histologic results do not correlate with symptoms and often patients are asymptomatic until the development of cirrhosis. " Cirrhosis is manifested by interlacing strands of fibrous tissue with nodules of regenerating cells resulting in a characteristic small and knobby-appearing liver. This form of injury is irreversible and can be exacerbated by heavy alcohol consumption and concomitant infection with HCV or HIV. Hepatic decompensation as a result of cirrhosis includes ascites, jaundice, variceal bleeding, and hepatic encephalopathy. The 5-year risk of decompensation after the development of cirrhosis is estimated to be 20%. ... 

The approach to diagnosing an adnexal mass discovered on pelvic examination depends on several factors, including the patient s reproductive age, adnexal mass size, menopausal status, and symptoms. Exploratory laparotomy is indicated in premenarchal women, women with masses greater than 8 cm, women with masses that increase or persist through several menstrual cycles or that are fixed to peritoneal surfaces, women with bilateral masses, or women with intra-abdominal pain or ascites. ... 

ABSORPTION, DISTRIBUTION, AND EXCRETION Isoniazid is readily absorbed after oral or parenteral administration. Isoniazid diffuses readily into aU body fluids and cells. The drug achieves significant quantities in pleural and ascitic fluids concentrations in the cerebrospinal fluid (CSF) with inflamed meninges are similar to those in the plasma. Isoniazid penetrates well into caseous material and persists in therapeutic concentrations. 

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