Read Essential Facts on the Go: Internal Medicine Online
Authors: Lauren Stern,Vijay Lapsia
Tags: #Medical, #Family & General Practice, #Internal Medicine
Essential Facts on the Go: Internal Medicine (14 page)
Ascites
III_1_b
Evaluation of Abnormal Liver Tests
Adapted with permission from Longo DL, et al.
Harrison’s Principles of Internal Medicine
, 18th ed. McGraw-Hill, 2012.
III_2_a
Cirrhosis
III_2_b
Ascitic Fluid Analysis
Albumin Gradient:
X = Serum Albumin – Acites Albumin
if X > 1.1g/dL, then portal hypertension
if X < 1.1g/dL, then not from portal hypertension
Etiology includes:
CHF, tricuspid insufficiency, constrictive pericarditis, venous occlusion (including Budd–Chiari syndrome), cirrhosis, pancreatitis, peritonitis (ruptured viscus, TB, bile leak, spontaneous bacterial), tumor (most common—ovarian, gastric, uterine, unknown primary, breast, lymphoma), trauma, Meigs syndrome (ovarian fibroma associated with hydrothorax and ascites), myxedema, anasarca (hypoalbuminemia)
Total Protein
< 1.0 g/dL, high risk of spontaneous bacterial peritonitis
Cell Count
Absolute neutrophil count > 250/L, presume infected
The threshold is lower (>100/L) in patients with peritoneal dialysis catheter in situ
Secondary Bacterial Peritonitis
• polymicrobial
• total protein > 1.0 g/dL
• LDH > normal serum value
• glucose < 50 mg/dL
Food Fibers
Found in most cases of perforated viscus
Cytology:
Bizarre cells with large nuclei may represent reactive mesothelial cells and not malignancy. Malignant cells suggest a tumor.
Note: The older classification of ascitic fluid as either transudative or exudative is no longer used.
III_3_a
Gastrointestinal Bleeding
III_3_b
Gastrointestinal Bleeding
Management
Airway