28. Ascites. Differential diagnosis of ascites

Question 1

what are other diseases which can cause hgh SERUM ASCITIS ALBUMIN GRADIENT OF MORE THAN 1.1 g/dl?

Answer 1

TRANSUDATE

portal hypertension in liver cirrhosis and acute liver failure

right sided heart failure , constrictive pericarditis

budd chiari syndrome

= cause high portal pressure

Question 2

what are other diseases which can cause low SERUM ASCITIS ALBUMIN GRADIENT OF LOWER THAN 1.1g/dl?

Answer 2

EXUDATE

protein loss enteropathy
nephrotic syndrome
severe malnutrition

pancreatitis

peritoneal carcinoma - blackage of lymphatic drainage

hypertension
d type 1

malignancy

Question 3

whata re the signs ?

Answer 3

adominal distenstion

Percussion note is tympanitic periumbilicus and transitioning to dull as we go distal to the umbilicus
there is also shifting dullness when person lays from supine to lateral decubitus position

positive fluid wave test

right sided heart failure - elevated jugular veins

Question 4

how do we diagnose this ?

Answer 4

USOUND THE BEST
talk about liver cirrhotic ultrasoung

ct scan

ultrasound guided - fluid aspiration or parenthesis

ascitic fluid analaysisi 
colour :
portal hypertension = clear
cloudy : chylous : collection of lymph in the abdominal cavity, which is characteristically triglyceride-rich and has a milky appearance
bloody : malignancy 
dark brown : biliary duct perforation
cell count  and diffrentiation 
PH - low 
non PH = high