Tuesday, December 15, 2009
December 15th - LBJ - Ascites
Our Second Case at LBJ Today was a patient with 3-4 weeks of abdominal distention (in this case, ascites). The diagnosis ending up being Alcoholic Hepatitis/Cirrhosis.
Just as a review, an Approach to a patient with ascites includes a differentiation based on the serum Albumin-Ascitic Gradient. This has a published accuracy of >97%!
If >1.1 - Consider Liver Disease/Portal Hypertension.
This can be broken into causes based on location:
Portal Vein Thrombosis
Schistosomiasis (in Egypt!)
Intrahepatic Causes (i.e "Cirrhosis)
NASH/NAFLD (i.e. obesity, dyslipidemia, insulin resistance)
Post-Hepatic Causes (i.e. "Congestion")
If <1.1: Think Low-Albumin States and non-portal hypertensive causes:
Infectious Peritonitis (TB and some fungal diseases)
Malignancy (Peritoneal Carcinomatosis, Ovarian Cancer, HCC, Psedomyxoma peritonii)
All you'll ever need to know about Ascites actually comes from the AASLD - it includes where to do your paracentesis, how to analyze fluid (including SBP and variants) and treatment:
AASLD Practice Guidelines for Cirrhosis and Ascites