Internal medicine notes

Apr 16th, 2015
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ASCITES & PERITONITIS.DR KIBIRU- MULIASCITES DEFN:Collection of excess fluid in the peritoneal cavity. Clinically detectable >500mls accumulates. Frequently encountered in patients with livercirrhosis, also found in many other conditions.CLASSIFICATIONGrade 1-mild ,detectable with ultrasound. Grade2-detectable with flank bulging &shiftingdullness. Grade3-grossly visible with fluid thrill. Can also be classified based on serum ascitisalbumin gradient(SAAG)HIGH SAAG >1.1G/dl-also known as transudate. Low SAAG<1.1g/dl-exudates.HIGH SAAG(TRANSUDATES)Low protein <30g/l Low LDH. High PH. Normal glucose. Fewer than 1wbc/ml.LOW SAAG(EXUDATES)High protein (albumin)>30g/l. High LDH. Low PH(<7.30). Low glucose. High WBC.PATHOGENESIS.Accumulation of ascitis represents a state of total body sodium and water excess, event initiating thisis unclear. Three(3) theories have been proposed. UNDERFILLING THEORY-primary abnormality isinappropriate sequestration of fluid in thesplanchnic vascular bed due to portal hypertensionwith decrease of effective circulating blood volume.CONT,The decrease in intravascular volume leads toactivation ofRenin-angiotensin aldosterone system. Sympathetic nervous system .Release of aldosterone leads to sodium retentionwith accompanying water retention.CAUSES.Hepatic cirrhosis . Malignancies-hepatic,peritonea

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