7 ASCITES General Discussion In the United States, approximately 80% of ascites is caused by cirrhosis while nonhepatic causes account for the remaining 20%. In patients with liver disease, portal hypertension leads to ascites formation. Paracentesis should be performed on all patients with new-onset, clinically apparent ascites. The incidence of ascitic fluid infection is 10–27% at the time of hospital admission. Patients with ascitic fluid infection may present with subtle symptoms, and early detection of infection with treatment at an early stage reduces morbidity and mortality. Diagnostic paracentesis should be repeated if a patient with ascites develops fever, abdominal pain, hypotension, abdominal tenderness, renal failure, encephalopathy, peripheral leukocytosis, or acidosis. The serum-ascites albumin gradient (SAAG) is useful in determining the cause of ascites and guiding management. When the SAAG is equal to or greater than 1.1 g/dL, the patient has portal hypertension as the cause of ascites. The differential diagnosis includes cirrhosis, alcoholic hepatitis, hepatocellular carcinoma, massive liver metastases, fulminant hepatic failure, cardiac ascites, myxedema, Budd–Chiari syndrome, portal vein thrombosis, veno-occlusive disease of the liver, acute fatty liver of pregnancy, and mixed ascites. When the SAAG is less than 1.1 g/dL, portal hypertension is not the cause of ascites. The differential diagnosis includes peritoneal carcinomatosis, tuberculous peritonitis, Chlamydia peritonitis, pancreatic ascites, biliary ascites, peritonitis from connective tissue disease such as lupus, bowel infarction, bowel perforation, and postoperative lymphatic leakage. Peritoneal carcinomatosis is the most common cause of ascites in patients with a low SAAG. Ascitic fluid polymorphonuclear (PMN) leukocyte count is a more reliable indicator for infection than ascitic fluid white blood cell count. In calculating the PMN count, one PMN is subtracted from the absolute ascitic fluid PMN count for every 250 red blood cells. A corrected ascitic fluid PMN count greater than 250 cells/mm3 should be treated as an ascitic fluid infection until proven otherwise. Causes of Ascites AIDS Biliary tree leakage Chemical burn to the peritoneum causing biliary or pancreatic ascites Chlamydia (Fitz–Hugh–Curtis syndrome) Coccidiomycosis Congestive heart failure Constrictive pericarditis Endometriosis Eosinophilic gastroenteritis Familial Mediterranean fever Glove starch peritonitis Hepatic vein thrombosis Hereditary angioedema Histoplasmosis Intrahepatic portal hypertension Lymphoma Meig’s syndrome Mesenteric lymphatic leakage Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: BLEEDING AND BRUISING GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on ASCITES Full access? Get Clinical Tree
7 ASCITES General Discussion In the United States, approximately 80% of ascites is caused by cirrhosis while nonhepatic causes account for the remaining 20%. In patients with liver disease, portal hypertension leads to ascites formation. Paracentesis should be performed on all patients with new-onset, clinically apparent ascites. The incidence of ascitic fluid infection is 10–27% at the time of hospital admission. Patients with ascitic fluid infection may present with subtle symptoms, and early detection of infection with treatment at an early stage reduces morbidity and mortality. Diagnostic paracentesis should be repeated if a patient with ascites develops fever, abdominal pain, hypotension, abdominal tenderness, renal failure, encephalopathy, peripheral leukocytosis, or acidosis. The serum-ascites albumin gradient (SAAG) is useful in determining the cause of ascites and guiding management. When the SAAG is equal to or greater than 1.1 g/dL, the patient has portal hypertension as the cause of ascites. The differential diagnosis includes cirrhosis, alcoholic hepatitis, hepatocellular carcinoma, massive liver metastases, fulminant hepatic failure, cardiac ascites, myxedema, Budd–Chiari syndrome, portal vein thrombosis, veno-occlusive disease of the liver, acute fatty liver of pregnancy, and mixed ascites. When the SAAG is less than 1.1 g/dL, portal hypertension is not the cause of ascites. The differential diagnosis includes peritoneal carcinomatosis, tuberculous peritonitis, Chlamydia peritonitis, pancreatic ascites, biliary ascites, peritonitis from connective tissue disease such as lupus, bowel infarction, bowel perforation, and postoperative lymphatic leakage. Peritoneal carcinomatosis is the most common cause of ascites in patients with a low SAAG. Ascitic fluid polymorphonuclear (PMN) leukocyte count is a more reliable indicator for infection than ascitic fluid white blood cell count. In calculating the PMN count, one PMN is subtracted from the absolute ascitic fluid PMN count for every 250 red blood cells. A corrected ascitic fluid PMN count greater than 250 cells/mm3 should be treated as an ascitic fluid infection until proven otherwise. Causes of Ascites AIDS Biliary tree leakage Chemical burn to the peritoneum causing biliary or pancreatic ascites Chlamydia (Fitz–Hugh–Curtis syndrome) Coccidiomycosis Congestive heart failure Constrictive pericarditis Endometriosis Eosinophilic gastroenteritis Familial Mediterranean fever Glove starch peritonitis Hepatic vein thrombosis Hereditary angioedema Histoplasmosis Intrahepatic portal hypertension Lymphoma Meig’s syndrome Mesenteric lymphatic leakage Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: BLEEDING AND BRUISING GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on ASCITES Full access? Get Clinical Tree
