Peritoneum

Question 1

Malignancy of peritoneal organ - Ascites

Answer 1

Blocked lymphatic channel
Highly active - direct fluid production
Hepatic metastases results in portal Hyptn

Question 2

Peritoneum - Parietal

Answer 2

Lines the wall of the abdominopelvic cavity

Question 3

Abdominal paracentesis - Color & Consistencies (3)

Answer 3

Cloudy = Infection Milky = Chyle Bloody = Traumatic/Malignant

Question 4

Hepatic Portal System - FX (2)

Answer 4

(1) supplies liver w/ metabolites

(2) ensures ingested substances are processed in the liver before reaching the systemic circulation

Question 5

Signs of liver disease

Answer 5

Muscle wasting

Malnourishment

Question 6

Bile Ascites

Answer 6

Due to complications from biliary tract surgery - Percutaneous liver biopsy - Abdominal trauma

Question 7

Pancreatic Ascites

Answer 7

Accumulation of massive amounts of pancreatic secretions

Question 8

Chylous Ascites + cause

Answer 8

Accumulation of lipid-rich lymph (chyle) (Milky)

Cause by lympatic obstruction (lymphoma)

Question 9

Ascites - Labs

Answer 9

Abdominal paracentesis WBC Count Albumin & TP

Question 10

Peritoneum - Visceral

Answer 10

Covers some of the organs in the cavity and is also considered their serosa

Question 11

Peritoneum - Structure

Answer 11

simple squamous epithelium (mesothelium) underlying layer of areolar connective tissue

Question 12

Ascites Imaging

Answer 12

ABD US -and/or CT

Question 13

Albumin - SAAG gradient - Serum minus Ascites = cutoff

Answer 13

> 1.1 = Portal HYPTN <1.1 = Other cause

Question 14

Ascites - Common causes

Answer 14

Portal Hypertension (Hepatic Congestion, Liver Disease)
Hypoalbuminemia
Chylous, pancreatic, bile ascites
Infections, malignancies

Question 15

Spontaneous Bacterial Peritonitis Treatment (4)

Answer 15

1. Admit 2. Empiric - IV 3rd Gen Cephalosporin 3. Cx + stain

Question 16

Spontaneous Bacterial Peritonitis (3) points

Answer 16

1. Infection of ascitic fluid in the absence of an intra-abdominal source of infection
2. Distinguish from secondary bacterial peritonitis (CT to discover source of infection ) 3. Recurrent

Question 17

Signs of portal hypertension

Answer 17

Hepatic enlargement (Pos/Neg tenderness)
Elevated JVP
Large abdominal wall veins

Question 18

Ascites due to Portal HOTN - Pathogenesis (5)

Answer 18

1. Cirrhosis
2. increased intrahepatic vascular resistance
3. increased capillary pressure
4. increased hepatic lymph formation
5. ascites

Question 19

Peritoneum

Answer 19

largest serous membrane in the body

Question 20

Pathologic Portal Hypertension

Answer 20

Pressure gradient between portal vein and IVC > 10 mmHg