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Old 05-20-2013
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Default gastroenterology q11 ascites

A 61-year-old male is admitted to your service for swelling of the abdomen. You detect ascites on clinical examination and perform a paracentesis. The results show a white blood cell count of 300 leukocytes/μL with 35% polymorphonuclear cells. The peritoneal albumin level is 1.2 g/dL, protein is 2.0 g/dL, and triglycerides are 320 mg/dL. Peritoneal cultures are pending. Serum albumin is 2.6 g/dL. Which of the following is the most likely diagnosis?

A. Congestive heart failure B. Peritoneal tuberculosis C. Peritoneal carcinomatosis D. Chylous ascites E. Bacterial peritonitis
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Originally Posted by cingulate.gyrus View Post
A 61-year-old male is admitted to your service for swelling of the abdomen. You detect ascites on clinical examination and perform a paracentesis. The results show a white blood cell count of 300 leukocytes/μL with 35% polymorphonuclear cells. The peritoneal albumin level is 1.2 g/dL, protein is 2.0 g/dL, and triglycerides are 320 mg/dL. Peritoneal cultures are pending. Serum albumin is 2.6 g/dL. Which of the following is the most likely diagnosis?

A. Congestive heart failure B. Peritoneal tuberculosis C. Peritoneal carcinomatosis D. Chylous ascites E. Bacterial peritonitis
SAAG (serum to albumin gradient/ratio) is less than 1.1, which basically means no portal hypertension is present...
It doesnt even matter.. with those leukocytes i believe this patient has SBP..

B could also be a right answer, as it is associated with chylous ascitic fluid.. but the predominance would be mononuclear cells instead of PMNs
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Originally Posted by XpaezX View Post
SAAG (serum to albumin gradient/ratio) is less than 1.1, which basically means no portal hypertension is present...
It doesnt even matter.. with those leukocytes i believe this patient has SBP..

B could also be a right answer, as it is associated with chylous ascitic fluid.. but the predominance would be mononuclear cells instead of PMNs
Your thoughts are correct but a calculation mistake, here SAAG is 1.5.
So its transudate .
PMN is not much elevated.It will be in thousands in exudates...
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Your thoughts are correct but a calculation mistake, here SAAG is 1.5.
So its transudate .
PMN is not much elevated.It will be in thousands in exudates...
lol XD!

then the answer is A
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The answer is A. Congestive heart failure
Diagnostic paracentesis is part of the routine evaluation in a patient with ascites. Fluid should be examined for its gross appearance, protein content, cell count and differential, and albumin. Cytologic and culture stud-ies should be performed when one suspects infection or malignancy. The serum-ascites albumin gradient (SAG) offers the best correlation with portal pressure. A high gradient (>1.1 g/dL) is characteristic of uncomplicated cirrhotic ascites and differentiates ascites caused by portal hypertension from ascites not caused by portal hypertension in more than 95% of cases. Conditions that cause a low gradient include more “exudative” proc-esses such as infection, malignancy, and inflammatory processes. Similarly, congestive heart failure and nephrotic syndrome cause high gradients. In this patient the SAG is 1.5 g/dL, indicating a high gradient. The low number of leukocytes and polymorpho-nuclear cells makes bacterial or tubercular infection unlikely. Chylous ascites often is characterized by an opaque milky fluid with a triglyceride level greater than 1000 mg/dL in addition to a low SAG.
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