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The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The abdomen should be examined for the presence of ascites from nutritional edema. Hepatomegaly (steatosis) may be due to non-alcoholic fatty liver disease (NAFLD), often seen with obesity, diabetes, hyperlipidemia, metabolic syndrome and high-glucose TPN. The abdomen appears scaphoid in PCM, marasmus, wasting diseases and cachexia.
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Progressive liver failure, associated with diagnoses such as cirrhosis, hepatitis, and primary or metastatic liver cancer (see Chapter 9, malignant neoplasms), often results in ascites. Ascites is the accumulation of fluid within the abdominal cavity, which in advanced cases, distends the abdomen causing discomfort, pressure, nausea, and bloating for the patient. Shortness of breath can also occur due to increased pressure on the diaphragm; if fluid migrates across the diaphragm, ascites can also cause pleural effusion. Bilateral lower extremity swelling, as well as umbilical hernia are possible with significant ascites. The severe sense of fullness, and tightness in the abdominal cavity and chest, often restricts comfortable range of motion and functional mobility. The diagnosis is typically made by physical exam, ultrasound, and/or MRI or CT scanning. When associated with disseminated cancer, it is referred to as malignant ascites.
The gastrointestinal system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Sharon J. White, Francis A. Carey
The peritoneum is a common site of secondary spread of neoplasms, often by direct spread of neoplastic cells from underlying organs (stomach, colon, pancreas, ovary). This occurrence may give rise to fluid accumulation (ascites). Occasionally, tumour cells may appear to migrate across the peritoneal cavity, forming distinct secondary deposits in other organs. The best example of this is the Krukenberg tumour, which involves the spread of diffuse-type gastric adenocarcinoma to the ovary.
Clinical presentation of peritoneal tuberculosis
Published in Baylor University Medical Center Proceedings, 2023
Nazli Begum Ozturk, Christos Tsagkaris, Naile Dolek, Raim Iliaz
Diagnosis of abdominal TB can be difficult given the nonspecific and variable clinical presentation. Most cases have symptoms persisting for weeks or months and present with ascites, abdominal pain, loss of appetite, weight loss, and fever.4,5 Ascites is the most common presenting symptom of PT, and it is present in approximately 90% of cases. High suspicion of PT is important in the setting of ascites of unknown origin. Although the ultrasound findings were suggestive of chronic liver disease in our patient, CT scan revealed normal liver findings, and the patient did not have any significant risk factors or any peripheral/laboratory findings of chronic liver disease. CT revealed normal liver imaging and was suggestive of peritoneal carcinomatosis. Peritoneal carcinomatosis, Budd-Chiari syndrome, malignancies causing carcinomatosis ascites (e.g., ovarian cancer, gastric cancer), and peritoneal lymphomatosis should be differentiated from PT, although that might be challenging due to overlapping findings on imaging. The absence of findings of chronic liver disease (palmar erythema, spider angiomata, dilated veins on abdomen, gynecomastia) increases the suspicion for PT.6
Distinguishing between the complications of Wilson disease-related cirrhosis and HBV-related cirrhosis
Published in Current Medical Research and Opinion, 2022
Hao-Jie Zhong, Yu-Pei Zhuang, Yi-Ting Zhang, Shun-Peng Xu, Ming-Fan Hong, Xing-Xiang He
“Alcoholism” was defined as alcohol consumption per week >140 g. Cirrhosis was diagnosed by histology or based on combined clinical, laboratory and imaging examinations15. Ascites was diagnosed based on compatible signs on examination and confirmed via imaging or paracentesis15. “SBP” was defined as a count of polymorphous clear cells in ascitic fluid >250/mm3 without an obvious surgically treatable, intra-abdominal source of infection16. Gastroesophageal varices and variceal bleeding were diagnosed via endoscopy or magnetic resonance imaging (MRI) and computed tomography (CT). “Renal impairment” was defined as an increase in the serum creatinine level over baseline >50% to >133 mmol/L17. “Hepatic encephalopathy” was defined based on West Haven criteria18. “Liver failure” was defined as the occurrence of hepatic encephalopathy and an international normalized ratio ≥1.519. Primary liver cancers, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), were diagnosed based on clinical symptoms, ultrasonography, CT, MRI and pathology. Neurologic manifestations mainly included tremors, dystonia, parkinsonism, dysarthria and dysphagia5. Psychiatric manifestations were mainly mood disturbances, psychoses and cognitive impairment5. Liver function was assessed according to the Child–Pugh classification, as described previously20.
Intraperitoneal therapy for gastric cancer peritoneal carcinomatosis
Published in Expert Review of Clinical Pharmacology, 2022
Kazuto Harada, Kohei Yamashita, Masaaki Iwatsuki, Hideo Baba, Jaffer A. Ajani
Systemic chemotherapy is a major treatment option for patients with PM, similar to patients with other distant metastases. However, patients with PM often cannot tolerate any regimens because of their severe symptoms, such as fatigue, appetite loss, and gastrointestinal obstruction. Moreover, much fluid load is limited because it causes an increase in ascites. Shirata et al. showed that fluoropyrimidine (S-1 or capecitabine) plus cisplatin regimen was effective and feasible for patients with peritoneal metastasis, but, median treatment duration and progression free survival time are quite short in patients with massive ascites compared with others [16]. Cisplatin or irinotecan might not be suitable for patients with PM with massive ascites or inadequate oral intake, while fluoropyrimidines plus L-OHP might be an optimal regimen for such patients [17]. In Japan, S-1 and docetaxel was reported to be a tolerable and effective treatment for patients with peritoneal dissemination [18]. Table 1 shows previous studies assessing the chemotherapy regimen in patients with massive ascites. In Japan, WJOG10517G, a multicenter Phase II study assessing efficacy of mFOLFOX6 in GAC patients with severe PM, is ongoing [19]