tailieunhanh - A practical guide to the management of medical emergencies - part 7

Cảm nhận di căn phúc mạc, nhưng những điều này được tìm thấy trong chỉ có khoảng hai phần ba số bệnh nhân với cổ trướng liên quan đến Tổng số bệnh ác tính glucose, protein, LDH Nhuộm Gram Ziehl-Neelsen vết bẩn và kiểm tra DNA lao Mycobacterium nếu nghi ngờ lao Amylase nếu nghi ngờ viêm tụy | CHAPTER 61 391 Test Comment Other tests peritoneal metastases but these are found in only about two-thirds of patients with ascites related to malignancy Total protein glucose LDH Gram stain Ziehl-Neelsen stain and testing for Mycobacterium tuberculosis DNA if suspected tuberculosis Amylase if suspected pancreatitis EDTA ethylene diaminetetra-acetic acid LDH lactate dehydrogenase. TABLE Causes of ascites according to the serum-ascites albumin gradient SAAG High SAAG 11 g L or greater associated with portal hypertension Cirrhosis Alcoholic hepatitis Hepatic outflow obstruction - Budd-Chiari syndrome thrombosis of one or more of the large hepatic veins the inferior vena cava or both - Hepatic veno-occlusive disease Cardiac ascites - Tricuspid regurgitation - Constrictive pericarditis - Right-sided heart failure Low SAAG 11 g L associated with peritoneal neoplasms infection and inflammation Peritoneal carcinomatosis Peritoneal tuberculosis Pancreatitis Serositis Nephrotic syndrome Myxedema Meig syndrome TABLE Spontaneous bacterial peritonitis Defined as spontaneous infection of ascitic fluid in the absence of an intra-abdominal source of infection It is a common complication of ascites due to cirrhosis Prevalence among patients with ascites is between 10 and 30 Causes fever 70 abdominal pain 60 abdominal tenderness 50 and change in mental state 50 Diagnosis based on finding of 250 neutrophils mm3 of ascitic fluid Aerobic Gram-negative bacteria especially Escherichia coli are the commonest organisms May be complicated by hepatorenal syndrome in up to 30 of patients see Table IV albumin solution kg at diagnosis and 1 g kg 48h later may reduce the likelihood of hepatorenal syndrome developing and improve prognosis Treat with third-generation cephalosporin . cefotaxime 2 g 8-hourly IV daily for 5 days followed by quinolone PO for 5 days Recurrence is common estimated 70 probablility of recurrence at 1 year . Consider prophylaxis with quinolone or .