Ascites

Color

ClearTurbidBloodyMilkyBrown + bilirubin>40Opalescent
CirrhosisInfectionHCC, traumatic tapping, cirrhosis, malignancy, Tuberculous peritonitisCirrhosis, malignancyRuptured gallbladder, perforated duodenal ulcer
Between turbid and milky

Lab data

Low Glucose- Infection, malignancy, bowel perforation

High LDH- Infection, malignancy, bowel perforation

High amylase- Pancreatitis, bowel perforation

Malignant ascites- Peritoneal carcinomatosis, liver metastasis, HCC, lymphoma


SAAG<1.1- Pancreatitis, serositis, Nephrotic syndrome, Peritoneal carcinomatosis, peritoneal tuberculosis, ruptured viscus

SAAG>1.1- Cirrhosis, Alcoholic hepatitis, Massive hepatic metastases, Heart failure/constrictive pericarditis, Budd-Chiari syndrome, Portal vein thrombosis, Idiopathic portal fibrosis


1.Spontaneous bacterial peritonitis

Diagnostic- Neutrophil>250, LDH<225, Glucose>50, Total protein<1

Treatment- Cefotaxime(2g q8h)

2.Bowel perforation, secondary bacterial peritonitis

Diagnostic- Neutrophil>250 + 2/3(Total protein>1, Glucose<50, LDH> 225)

Treatment- Piperacillin-tazobactam, cefoxitin, ampicillin+metronidazole+cirpofloxacin


*Portal hypertension- Portal vein>=13mm, SMV/Splenic vein>=11mm, splenomegaly>12cm

*Heart failure→  Protein>2.5, cirrhosis→ Protein<2.5


Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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