Difficulty in positive diagnosis of ascites and in differential diagnosis of a pulmonary tumor m ircea c a t a lin f or t ofoiu 1,2, d rago s m arian p opescu 3, v lad p a dureanu 1,4. Pdf difficulty in positive diagnosis of ascites and in. Treatment of malignant ascites in patients with advanced cancer. Diagnosis and management rita sood abstract ascites, the collection of fluid in the peritoneal cavity, occurs with a variety of disease states. Ascites can be classified by the underlying pathophys iological mechanism. Peritonitis and abdominal sepsis differential diagnoses. To find out differential ct scan diagnosis for cirrhotic and malignant ascites 322 p j m h s vol. When a case of feline ascites is presented to the veterinary surgeon, a logical and thorough diagnostic approach is required to determine the cause. Types of ascites and their pathogenesis under normal circumstances, the amount of peritoneal fluid depends on a balance between plasma flowing into and out. At the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. The concept of transudate versus exudate, as determined by total protein measurements, is outdated and the use of serum ascites albumin gradient as an. Ultrasound, computed tomography scan, or magnetic resonance imaging can confirm the diagnosis.
Listing a study does not mean it has been evaluated by the u. It can result fromaccumulation oftransudative or exudativefluid, chylouseffusions, blood, urine or bile. Ascites is a pathological collection of fluid in the peritoneal cavity. New biochemical parameters in the differential diagnosis. The differential diagnosis of ascites often leads to confusion and an inability to exclude its multitude of causes in many patients. The serumascites albumin gradient is far more useful than the aftp as a marker for portal hypertension, but the latter remains a useful adjunct in the differential diagnosis of ascites. The first report by pare 53 of saag in the differential diagnosis of ascites used the cutoff established by hoefs of 11 gl. Chapter 91 ascites and spontaneous bacterial peritonitis bruce a. Pdf ascitic fluid analysis in the differential diagnosis of. Ascites is the abnormal accumulation of fluid in the peritoneal cavity and is not a diagnosis in itself, but a clinical sign of disease.
Making a correct diagnosis is one of the key aspects of every medical students and junior. However, other less common causes of ascites should be evaluated in the differential. Not all patients with a protruberant abdomen or history of increasing abdominal girth have ascites. Its use is not recommended in patients with ascites of any type. The serumascites albumin gradient is superior to the. Akriviadis ea, kapnias d, hadjigavriel m, mitsiou a, goulis j. Differential diagnosis ascites refers to the pathologic accumulation of fluid within the peritoneal cavity.
Apr 27, 2015 common studies conducted on ascitic fluid include cell count and differential, albumin, protein, cytology, and cultures. The word ascites is of greek origin askos and means bag or sac. Ascitic fluid analysis in the differential diagnosis of. Pdf meconium peritonitis in the differential diagnosis. In cirrhosis, it is associated with circulatory dysfunction characterized by. Types of ascites and their pathogenesis under normal circumstances, the amount of peritoneal fluid depends on a balance between plasma flowing into and out of. Focus on cirrhotic ascites, authorlinlin huang and harry huaxiang xia and senlin zhu, journaljournal of clinical and translational hepatology. The following conditions may give a false positive appearance of ascites. Diagnosis of ascites in infants and children full text. Evaluation of ascites differential diagnosis of symptoms bmj best. Fortythree patients with ascites were evaluated with computed tomography ct. Prenatal ultrasound findings include fetal ascites and intraabdominal calcifications. Most cases of ascites in the united states result from liver.
It is the most common complication of cirrhosis, which is also the most common cause of ascites. Other common causes include malignancy and heart failure. The most common cause is cirrhosis, accounting for approximately 75% to 80% of cases. Diagnosis of ascites in infants and children full text view. Nov 14, 2017 diagnosis of ascites in infants and children ascites the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
The gross appearance of the fluid may be helpful in determining the pathologic process. Pancreatic disease pancreatic ascites develops as a complication of severe acute pancreatitis, pancreatic duct rupture in acute or chronic pancreatitis, or leakage from a pancreatic pseudocyst. The aim of the present study was to compare the diagnostic accuracy of the serumascites albumin gradient, proposed as a new biochemical criterion for the differential diagnosis of ascites, with the markers traditionally used for the classification of peritoneal fluid into. Churchills pocketbook of differential diagnosis download. It can result from accumulation of transudative or exudative fluid, chylous effusions, blood, urine or bile. Our results suggest that an elevated gradient is usually associated with in.
Evaluation of tumor markers for the differential diagnosis. Pdf meconium peritonitis in the differential diagnosis of. The ob was empty whenever the amount of ascites was low or moderate in the gpc 12 of. Ascites is one of the most frequent complications of cirrhosis. It is one of the earliest and most common complication of chronic liver disease. Ascitic fluid analyses indicating gross appearance, biochemical tests e. Churchills pocketbook of differential diagnosis third. A positive tuberculin skin test or serum quantiferon may provide help in putting tb on the list of differential diagnosis, but is unable to. Jul 23, 2019 peritonitis is defined as an inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. Successful treatment of ascites depends upon an accurate diagnosis of its cause table 1 and table 2 and table 3 and.
Review the diagnostic workup in patients with ascites. The exudatetransudate concept should be discarded in the classification of ascites. Assessment of ascites differentials bmj best practice. Management of adult patients with ascites due to cirrhosis. The role of ascitic fluid viscosity in the differential. Role of serumascites albumin gradient in differential diagnosis of ascites article pdf available in journal of ayub medical college, abbottabad. The churchills pocketbook gives a deep insight as well as a quick view to the differential diagnosis that can be made up with a symptom or sign. Analysis of the ascitic fluid is useful in the differential diagnosis of ascites. Diagnosis of ascites in infants and children ascites the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Ascites is the pathologic accumulation of fluid within the peritoneal cavity. The concept of transudate versus exudate, as determined by total protein measurements, is outdated and the use of serumascites albumin gradient as an. Common studies conducted on ascitic fluid include cell count and differential, albumin, protein, cytology, and cultures. A positive tuberculin skin test or serum quantiferon may provide help in putting tb. Evaluation of tumor markers for the differential diagnosis of. Approach to the patient with ascites differential diagnosis ascites refers to the pathologic accumulation of fluid within the peritoneal cavity. Jolles1 fortythree patients withasciteswereevaluated withcomputed tomography ct. Pdf ascitic fluid analysis in the differential diagnosis. Routinely, a cell count and differential should be performed on ascitic. Ascites might be the results of the physiological or pathological status, and the underlying mechanisms varied greatly in the different genders.
Evaluation of ascites differential diagnosis of symptoms. Pdf ascites is the pathologic accumulation of fluid within the peritoneal cavity. Mar 08, 2016 akriviadis ea, kapnias d, hadjigavriel m, mitsiou a, goulis j. Approach to the patient with ascites differential diagnosis. Role of serumascites albumin gradient in differential. Because many diseases can cause ascites, in particular cirrhosis, samples of ascitic fluid are commonly analyzed in order to develop a differential diagnosis. Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. The serum ascites albumin gradient is far more useful than the aftp as a marker for portal hypertension, but the latter remains a useful adjunct in the differential diagnosis of ascites. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis.
These studies can be used to evaluate the patient for both infectious and. Both groups proposed that saag was more effective than tp, ld or ratios of these tests in correctly identifying the. Update on the differential diagnosis of gynecologic organ. The obese patient with a lax anterior abdominal wall may have a protuberant umbilicus everted umbilicus sign.
Nephrotic syndrome constrictive pericarditis tb peritonitis chylous ascites buddchiari syndrome bcs meigs syndrome 33. Differential diagnosis of ascites should be based on saag because diagnostic efficacy of saag was significantly higher than aftp in workup of ascites. Saag, ldh, glucose, amylase, and ada, and nonbiochemical tests e. Because many diseases can cause ascites, in particular cirrhosis. In the united states, ascites is most often due to portal hypertension resulting from cirrhosis. Mar 15, 2014 ascites is one of the most frequent complications of cirrhosis. Successful treatment of ascites depends upon an accurate diagnosis of its. Ascites describes the condition of pathologic fluid collection within the abdominal cavity. It is important to establish a cause for its development and to initiate a rational treatment regimen to avoid some of the complications of ascites. The serumascites albumin gradient is superior to the exudate. It is a symptom of numerous medical conditions and has a broad differential diagnosis. New biochemical parameters in the differential diagnosis of.
Churchills pocketbook of differential diagnosis download pdf. Peritonitis is defined as an inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. Runyon chapter outline pathogenesis of ascites 1517 cirrhotic ascites 1517 noncirrhotic ascites 1517 clinical features 1518 history 1518 physical examination 1518 diagnosis 1519 abdominal paracentesis 1519 ascitic fluid analysis 1521 differential diagnosis of ascites 1527 complications 1528 ascitic fluid infection. Portal hypertension in cirrhosis abdominal malignancy ccf 31. Pdf ascitic fluid analysis in the differential diagnosis of ascites. Ascitic fluid analysis in the differential diagnosis of ascites. Underlying cirrhosis is present in many patients with pancreatic ascites. A physiologic approach to the differential diagnosis of ascites pierre pare, jean talbot, and john c. Aug 17, 2018 at the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. Ascites, serumascites albumin gradient, ascitic fluid total protein introduction the term ascites denotes the pathologic.
Churchills pocketbook of differential diagnosis pdf 4th. Methods in this prospective study, 398 consecutive patients with ascites were included. Pdf role of serumascites albumin gradient in differential. In the majority of patients the history and examination will provide important clues as to the etiology of ascites e. To find out differential ctscan diagnosis for cirrhotic. The peritoneum, which is an otherwise sterile environment, reacts to various pathologic stimuli with a fairly uniform inflammatory response. A total of 437 patients were enrolled, and the relevant parameters of the patients were analyzed for the differentiation of benign ascites from malignant ascites. Ascites is a pathological accumulation of fluid in the peritoneal cavity. The utility of differentiating ascites into transudate and exudate has recently been challenged. Serumascites albumin gradient saag the saag indirectly measures portal pressure and can be used to determine if ascites is due to portal hypertension. Differential diagnosis ofascites in cats severinetaskerand danielle gunnmoore ascites is the abnormal accumulation of fluid in the peritoneal cavity and is nota diagnosis in itself, buta clinical sign of disease. It should be emphasized that physicians should use the ascitic fluid analysis in combination with clinical, pathological, and imaging data, in. Churchills pocketbook of differential diagnosis third edition pdf download churchills pocketbook of differential diagnosis third edition is good book to read and comes with all the essential information that we need for our medical school to solve the cases. For example, in people with history of cirrhosis with ascites, spontaneous bacterial peritonitis should be high on the differential, but anchoring to that can lead to missing the right diagnosis.
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