Medicine an Surgery notes

Apr 24th, 2015
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HOSPITAL GRANDROUNDPRESENTATION. DEPARTMENTOF INTERNAL MEDICINE - 7THMAY 09ASCITESPRESENTERS;DR MASIKA (M.O.I.)DR LYNDA K.(M.O.)MODERATOR; DR J.KIYIAPI (H.O.D,PHYSICIAN)ASCITES Ascites means a bag or a sac (greek originAskos) Describes the condition of pathologic fluidaccumulation in the abd. cavity Men- little or no peritoneal fluid Women- may have upto 20mlsPathophysiology of Ascites A state of total body sodium and waterexcess (due to renal Na & H2O retention) Theories of Ascites formation The underfilling theory The overflow theory The peripheral arterial vasodilatationhypothesisPublic Health Importance the 3yr mortality rate for ascites is 50% If Ascites is refractory to treatment itcarries a 1yr survival rate less than 50%(poorer prognosis)CLINICAL APPROACH TO THEPATIENT WITH ASCITESHISTORY Risk factors for liver disease; alcohol use, abuse, duration Chronic viral hepatitis or jaundice IVDA Sexual orientation, promiscuity Blood transfusion- Hep C infection Tattoos Habitation or origination from an area endemicfor hepatitis Any hx of pain? Abd pain ass with ascitesis more likely to be malignant Renal symptoms for nephrotic ascites Cardiac symptoms for cardiogenic ascites Risk factors for non- alcoholicsteatohepatitis in type 2 DM,hypercholesterolemia & obesity- maycause cirrhosis & subsequent ascitesPhysical Exam Physical signs su

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