Essential Facts on the Go: Internal Medicine (14 page)

Ascites

ARDS

Multiorgan failure

Splenic vein thrombosis

III_1_b
Evaluation of Abnormal Liver Tests

Adapted with permission from Longo DL, et al.
Harrison’s Principles of Internal Medicine
, 18th ed. McGraw-Hill, 2012.

III_2_a
Cirrhosis

III_2_b
Ascitic Fluid Analysis

Albumin Gradient:

X = Serum Albumin – Acites Albumin

if X > 1.1g/dL, then portal hypertension

if X < 1.1g/dL, then not from portal hypertension

Etiology 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 peritonitis

Cell Count

Absolute neutrophil count > 250/L, presume infected

The threshold is lower (>100/L) in patients with peritoneal dialysis catheter in situ

Secondary Bacterial Peritonitis

• polymicrobial

• total protein > 1.0 g/dL

• LDH > normal serum value

• glucose < 50 mg/dL

Food Fibers

Found in most cases of perforated viscus

Cytology:

Bizarre cells with large nuclei may represent reactive mesothelial cells and not malignancy. Malignant cells suggest a tumor.

Note: The older classification of ascitic fluid as either transudative or exudative is no longer used.

III_3_a
Gastrointestinal Bleeding

III_3_b
Gastrointestinal Bleeding

Management

Check ABCs

Airway

Breathing

Circulation

2 large bore IVs: