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Old 11-07-2012
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Arrow Gyrus Daily Questions; Internal Medicine #75

A 61-year-old woman conies to her doctor's office for steadily increasing abdominal girth and fatigue with mild exertion She has noticed this symptom for the past few months She reports a 5-kg (11-lb) increase in her weight without making any change in her regular diet Her past medical history is unremarkable, although she has not seen a physician for many years She denies smoking. but admits drinking a glass of wine with meals on weekends On physical examination, she is afebrile and normotensive Examination of her abdomen reveals shifting dullness and a fluid wave, with clear distension A bedside ultrasound is performed. which demonstrates a large amount of ascific fluid Which of the following conditions is the most likely cause of this patient's current condition?


A. Alcoholic cirrhosis
B. Budd-Chiari syndrome
C. Peritoneal carcinomatosis
D. Portal vein thrombosis
E. Right heart failure
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Old 11-07-2012
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Originally Posted by cingulate.gyrus View Post
A 61-year-old woman conies to her doctor's office for steadily increasing abdominal girth and fatigue with mild exertion She has noticed this symptom for the past few months She reports a 5-kg (11-lb) increase in her weight without making any change in her regular diet Her past medical history is unremarkable, although she has not seen a physician for many years She denies smoking. but admits drinking a glass of wine with meals on weekends On physical examination, she is afebrile and normotensive Examination of her abdomen reveals shifting dullness and a fluid wave, with clear distension A bedside ultrasound is performed. which demonstrates a large amount of ascific fluid Which of the following conditions is the most likely cause of this patient's current condition?


A. Alcoholic cirrhosis
B. Budd-Chiari syndrome
C. Peritoneal carcinomatosis
D. Portal vein thrombosis
E. Right heart failure
Old, female WITHOUT risk factors for cirrhosis the most common cause is an Ovarian cancer.. Must rule it out.

Answer is C.
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i agree with the above statement......C
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C. Peritoneal carcinomatosis
most likely from ovarian ca.
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Old 11-08-2012
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Yes it is correct..

The correct answer is C.

This patient has new-onset ascites. which has a fairly broad differential diagnosis Ascites can form by several mechanisms

Exudative ascites may be the consequence of neoplasia. infection, or inflammatory states

Transudafive ascites is most commonly associated with liver cirrhosis, congestive heart failure. Budd-Chiari syndrome. and hepatic metastases

Sinusoidal or post-sinusoidal increased pressure is usually required for transudafive ascites to develop A new-onset diagnosis of ascites in an elderly female must warn the physician for the possibility of ovarian cancer Ovarian cancer is the second most common gynecologic malignancy in the United States. and the most common cause of death among gynecologic malignancies. It also constitutes the fifth most common cause of cancer deaths in women.
One of the late complications of ovarian cancer is peritoneal carcinomatosis. which occurs when the ovarian cancer metastasizes in the peritoneal cavity. In this patient without risk factors or common symptoms for any of the other listed conditions, ovarian cancer with peritoneal carcinomatosis should be considered
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