Diseases of peritoneum

Question 1

What is ascites?

Answer 1

Pathologic accumulation of fluid in the peritoneal cavity

Question 2

What is normal for men and women and fluid in the intraperitoneal space?

Answer 2

Men = no fluid

Women = 20 mL

Question 3

What is the most common cause of ascites?

Answer 3

Portal hypertension secondary to liver disease

Question 4

What is the numerical definition of portal hypertension?

Answer 4

Pressure difference between portal vein and IVC of 10+ mmhg

Question 5

How does cirrhosis cause ascites?

Answer 5

Cirrhosis –> increased intrahepatic vascular resistance –> increased capillary pressure –> increased hepatic lymph formation –> ASCITES

Question 6

What are the PE findings of Ascites?

Answer 6

1. Signs of portal hypertension
   Hepatic enlargement w/wo tender
   elevated JVP
   Large abd wall veins
2. Signs of liver disease
   Muscle wasting and malnourishment

***If you have fever than think Bacterial Peritonitis

Question 7

Describe findings from abdominal paracentesis and studies to be performed on fluid.

Answer 7

1. Inspect fluid
   Cloudy –> infection
   Milky –> Chyle
   Bloody –> trauma or malignant

Other :
WBC, Albumin and total prots, Culture and Stain

** SAAG

Question 8

What imaging stuies are used w/ ascites patients

Answer 8

Ultrasound - fluid AND guidance

ABD CT

Question 9

Describe Serum-Ascites Albumin Gradient (SAAG) formula and findings

Answer 9

Serum albumin - Ascitic fluid albumin

1.1 g/dL or mor = portal hypertension

less = other causes

Question 10

Describe Spontaneous Bacterial Peritonitis. What is it typically due to?

Answer 10

Infection of ascitic fluid in absence of an intra-abdominal source *****Distinguish from secondary

**Usually results from chronic liver disease

Question 11

Commonly, what pathogens are causes of Spontaneous bacterial peritonitis?

Answer 11

E coli
Klebsiealla Pneumo
Strep Pneumo
Strep Viridans
Enterococcus

Question 12

Does spontaneous bacterial peritonitis present with abdomina TTP?

Answer 12

NO. Usually presents with ascites and fever

If TTP then think other source

Question 13

What is the most important lab test for spont bacterial peritonitis?

Answer 13

Paracentesis for eval of ascetic fluid. Gram stain/cell count.

If secondary suspecte –> ABD CT

Question 14

How do you treat spont bacterial peritonitis?

Answer 14

ADMIT your patient so they can get IV ceftriaxone (rocephin) emperic. Once cultures –> specific

Prophylaxis due to reccurent problem - once daily cipro of septra… still 20% ish risk

Question 15

Describe the 3 possible process of malignant ascites

Answer 15

1. blocked lymphatic channels
2. direct production of fluid (highly active)
3. “Functinal” cirrhosis from extensive hepatic mets

Question 16

Chylous ascites is an accumulation of lipid rich lymph (aka ______) in the peritoneal cavity. It is ________ in appearance and is due to lymphatic _________ (lymphoma)

Answer 16

Chyle

milky white

obstruction

Question 17

Massive amounts of pancreatic secretions will cause what condition? Why does this happen?

Answer 17

Pancreatic ascites.

Disruption of panc. duct/Chronic pancreatitis

Question 18

Look at the other misc. conditions

Answer 18

Ok