Essential Facts On The Go: Internal Medicine - Plot & Excerpts
Essential Facts on the Go: Internal Medicine III_2_b Ascitic Fluid AnalysisAlbumin Gradient:X = Serum Albumin – Acites Albuminif X > 1.1g/dL, then portal hypertensionif X < 1.1g/dL, then not from portal hypertensionEtiology includes:CHF, tricuspid insufficiency, constrictive pericarditis, venous occlusion (including Budd–Chiari syndrome), cirrhosis, pancreatitis, peritonitis (ruptured viscus, TB, bile leak, spontaneous bacterial), tumor (most common—ovarian, gastric, uterine, unknown primary, breast, lymphoma), trauma, Meigs syndrome (ovarian fibroma associated with hydrothorax and ascites), myxedema, anasarca (hypoalbuminemia)Total Protein< 1.0 g/dL, high risk of spontaneous bacterial peritonitisCell CountAbsolute neutrophil count > 250/L, presume infectedThe threshold is lower (>100/L) in patients with peritoneal dialysis catheter in situSecondary Bacterial Peritonitis• polymicrobial• total protein > 1.0 g/dL• LDH > normal serum value• glucose < 50 mg/dLFood FibersFound in most cases of perforated viscusCytology:Bizarre cells with large nuclei may represent reactive mesothelial cells and not malignancy.
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