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Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
Approach to ascites
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Approach to ascites

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Some slides for the topic for SSS ID (Kahov) today!

Some slides for the topic for SSS ID (Kahov) today!

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  • (B2A2P1A3E0)\n
  • (B2A2P1A3E0)\n
  • (B2A2P1A3E0)\n
  • (B2A2P1A3E0)\n
  • (B2A2P1A3E0)\n
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  • (B2A2P1A3E0)\n
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  • TCP, leucopenia, anemia\nhNA, hK\nHRS, DM\nALT, AST, bilirubin\nINR\n
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  • Meig = ascite + Rt pleural effusion + benign ovarian fibroma\n
  • Meig = ascite + Rt pleural effusion + benign ovarian fibroma\n
  • Meig = ascite + Rt pleural effusion + benign ovarian fibroma\n
  • Meig = ascite + Rt pleural effusion + benign ovarian fibroma\n
  • Meig = ascite + Rt pleural effusion + benign ovarian fibroma\n
  • Meig = ascite + Rt pleural effusion + benign ovarian fibroma\n
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  • Transcript

    • 1. This gentleman hasabdominal distention, pleaseexamine him.
    • 2. Before you start doing PE,think……
    • 3. Before you start doing PE,think…… What is the differential diagnosis of abdominal distention?
    • 4. Before you start doing PE,think…… What is the differential diagnosis of abdominal distention? Remember 5F’s  Fat  Flatulence  Feces  Fluid  Fetus
    • 5. Before you start doing PE,think…… What is the differential diagnosis of abdominal distention? Remember 5F’s  Fat  Flatulence  Feces  Fluid  Fetus What are some of the causes of ascites?
    • 6. Ascites GIT (Liver diseases) CVS (CCF) Nephro Lymph Etc…Bear these in your mind so that you know what to look for…
    • 7. General condition+ Yellow discoloration of skin+ Cachetic appearance
    • 8. Upper Limbs+ Finger clubbing+ Palmar erythemao Liver flapo Leukonychiao Dupuytren’s contracture+ Scratch marks+ Scars on cubital fossa+ Tattoo scar on shoulder
    • 9. Head+ Yellow discolouration of sclerao Pallor of conjunctivao Kayser-Fleischer ringo Puffy eyeo Parotid swellingo Lymphadenopathyo Oral candidiasis
    • 10. Neck+ Virchow nodeo JVP distention
    • 11. Chest+ Virchow node+ Gynaecomastia+ Spider naevi+ Loss of axillary hairo Apex beat displacement Dual rhythm, no murmur (DRNM)o Gallop rhythm (S3/S4)
    • 12. Abdomen+ Abdominal distention+ Scar on abdomen+ Dilated veins+ Inverted umbilicus
    • 13. Abdomen+ Hepatomegaly, describe: tender, hard, nodular, 2 FB below costal margin. Liver span 12cm+ Splenomegaly, dull sound on Traube’s space Try to ballot the kidney+ Hepatic bruit + Bowel soundo Splenic rub o Renal bruit
    • 14. AbdomenCheck shifting dullnessCheck fluid thrills
    • 15. Lower limbs+ Bilateral pedal edema until level below the knee
    • 16. Complete your PE with: Check the testes Check for lymphadenopathy Per rectum (PR) examination Some investigations to find underlying cause
    • 17. How to present &conclude? Your findings Possible Dx, DDx Severity Functional status, failure? Complication? Etiology Associating syndrome
    • 18. For example…
    • 19. For example… Findings : Stigmata of chronic liver disease sign of risk factor
    • 20. For example… Findings : Stigmata of chronic liver disease sign of risk factor Dx, lesion: Cirrhosis, Hepatosplenomegaly
    • 21. For example… Findings : Stigmata of chronic liver disease sign of risk factor Dx, lesion: Cirrhosis, Hepatosplenomegaly Severity : Child-Pugh Score
    • 22. For example… Findings : Stigmata of chronic liver disease sign of risk factor Dx, lesion: Cirrhosis, Hepatosplenomegaly Severity : Child-Pugh Score Fx status : Ascites, liver failure
    • 23. For example… Findings : Stigmata of chronic liver disease sign of risk factor Dx, lesion: Cirrhosis, Hepatosplenomegaly Severity : Child-Pugh Score Fx status : Ascites, liver failure Complic : Hepatocellular carcinoma (HCC) no hepatic encephalopathy
    • 24. For example… Findings : Stigmata of chronic liver disease sign of risk factor Dx, lesion: Cirrhosis, Hepatosplenomegaly Severity : Child-Pugh Score Fx status : Ascites, liver failure Complic : Hepatocellular carcinoma (HCC) no hepatic encephalopathy Etiology : Hep B / Hep C
    • 25. For example… Findings : Stigmata of chronic liver disease sign of risk factor Dx, lesion: Cirrhosis, Hepatosplenomegaly Severity : Child-Pugh Score Fx status : Ascites, liver failure Complic : Hepatocellular carcinoma (HCC) no hepatic encephalopathy Etiology : Hep B / Hep C Assoc : Portal Hypertension
    • 26. Empahsize… Stigmata of chronic liver disease Risk factors: IVDU, tattoo  Hep B/C HCC (hepatic bruit), is there encephalopathy Child-Pugh score if have investigation result Portal hypertension (splenomegaly) Probable cause: Hep B/C  confirm with Ix Provide suitable negative sign to exclude other DDx
    • 27. InvestigationBasic: FBC, RP, U&E, LFT Coag profile Urine protein US, CT
    • 28. InvestigationSpecific: Hep B, C αFP ANA, AMA, ASMA, ALKMA Iron profile Urine Cu, serum ceruloplasmin Diagnostic peritoneal tap Liver biopsy OGDS
    • 29. Main causes of ascites?
    • 30. Main causes of ascites? Portal hypertension in cirrhosis Abdominal malignancy CCF
    • 31. Less common causes?
    • 32. Less common causes? Nephrotic syndrome Constrictive pericarditis TB peritonitis Chylous ascites Budd-Chiari syndrome (BCS) Meig’s syndrome
    • 33. Transudate / Exudate?
    • 34. Transudate / Exudate? Protein < 25 g/l  Transudate Protein > 25 g/l  Exudate
    • 35. What is ‘serum-ascitesalbumin gradient’ (SAAG)?
    • 36. What is ‘serum-ascitesalbumin gradient’ (SAAG)? SAAG = serum alb – ascitic alb
    • 37. What is ‘serum-ascitesalbumin gradient’ (SAAG)? SAAG = serum alb – ascitic alb > 11g/l  + Portal HPT (transudative) < 11g/l  o Portal HPT (exudative)
    • 38. SAAG > 11 SAAG < 11 Cirrhosis  Peritoneal Alcoholic hep carcinomatosis CCF  Peritoneal TB BCS  Nephrotic syndrome Fulminant liver  Serositis failure  Pancreatic / biliary ascites
    • 39. +Pedal o Pedal edemaedema Portal HPT  TB ascites CCF  BCS Nephrotic syndrome  Malignancy: Hypoalbuminenia Hepatoma Stomach Pancreas Ovarian
    • 40. Possible complications in this
    • 41. Possible complications in this Ascites:  Breathing problem  Spontaneous bacterial peritonitis (SBP) Chronic liver disease:  Hepatocellular carcinoma (HCC)  Hepatic encephalopathy Portal HPT:  Upper GI bleeding (UGIB)  Hemorrhoid
    • 42. When can you dx SBP?
    • 43. When can you dx SBP? Symptoms: fever, abd pain, no bowel sound, altered mental status In ascitic fluid there is either: >500 WBC / µl, or >250 PMN / µl No local infectious source
    • 44. 1o & 2o prophylaxis in UGIB dueto oesophgeal varices rupture?
    • 45. 1o & 2o prophylaxis in UGIB dueto oesophgeal varices rupture? 1o prophylaxis: no UGIB yet need to prevent it from happening
    • 46. 1o & 2o prophylaxis in UGIB dueto oesophgeal varices rupture? 1o prophylaxis: no UGIB yet need to prevent it from happening 2o prophylaxis: got UGIB already need to prevent recurrence
    • 47. 1o & 2o prophylaxis in UGIB dueto oesophgeal varices rupture? 1o prophylaxis: no UGIB yet need to prevent it from happening 2o prophylaxis: got UGIB already need to prevent recurrence Propanolol
    • 48. 1o & 2o prophylaxis in UGIB dueto oesophgeal varices rupture? 1o prophylaxis: no UGIB yet need to prevent it from happening 2o prophylaxis: got UGIB already need to prevent recurrence Propanolol Endoscopic banding
    • 49. How will you manage thispt?
    • 50. How will you manage thispt? Sodium restriction Fluid restriction Diuretic: Lasix + Spironolactone Peritoneal tap + albumin infusion TIPSS LeVeen’s Peritoneojugular shunt Liver transplant
    • 51. Treating chronic liverdiseases Viral hep : Antiviral Autoimm. hep : Steroids Alcoholism : Stop alcohol
    • 52. When need livertransplant?
    • 53. When need livertransplant?Milan criteria for cirrhosis / HCC: 1 lesion <5 cm, or 2-3 lesions <3 cm No extra-hepatic manifestation No vascular invasion
    • 54. When need livertransplant?Milan criteria for cirrhosis / HCC: 1 lesion <5 cm, or 2-3 lesions <3 cm No extra-hepatic manifestation No vascular invasionOther criteria: King’s College Hospital Criteria
    • 55. When need livertransplant?Milan criteria for cirrhosis / HCC: 1 lesion <5 cm, or 2-3 lesions <3 cm No extra-hepatic manifestation No vascular invasionOther criteria: King’s College Hospital Criteria Model of End-stage Liver Disease (MELD)
    • 56. Thank You Not only youcan have ascites

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