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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
Conservative management of ascites usually involves a low sodium diet, fluid restriction, and the use of diuretics. Therapeutic paracentesis, when up to several liters of fluid are removed with a large-gauge needle, can help to relieve painful pressure. For patients with chronic or malignant ascites, paracentesis can be done on a routine basis for palliation for pressure relief and comfort, though it has a side effect of progressive weakness from protein loss. For refractory cases where minor surgery or interventional radiology procedures are a choice and a viable option, transjugular intrahepatic portosystemic shunts (TIPS), peritoneovenous shunts (e.g. Denver) and ports, and implanted catheter vacuum drainage systems (e.g. PleurX) may be considered when severe symptoms are not controlled by other interventions. In the case of malignant ascites, intraperitoneal chemotherapy (including palliative hyperthermic intraperitoneal chemotherapy [HIPEC]) may also be a consideration.70
Cirrhosis in Surgery
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Cirrhotic patients with spontaneous bacterial peritonitis who received early as compared to delayed paracentesis had lower mortality (13% vs. 27%, P = 0.007) and each hour delay in paracentesis was associated with a 3.3% increase in mortality. Paracentesis performed less than 12 hours from admission may improve survival (Kim et al., 2014). In contrast to many cirrhotic complications, portal vein thrombosis can be a consequence of the progression of liver disease and may not be responsible for further progression of liver disease (Nery et al., 2015). This longitudinal study noted the cumulative incidence of portal vein thrombosis in patients with cirrhosis was 4.6%, 8.2%, and 10.7% at 1, 3, and 5 years. Although patients with more severe liver disease were at a higher risk for developing portal vein thrombosis, the progression of liver disease such as the development of ascites, reduced portal blood flow velocity, or other variables for liver decompensation were independent of the presence of portal vein thrombosis.
Congenital and Perinatal Anomalies of the Gastrointestinal Tract
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
The management of the fetus with nonimmune hydrops fetalis should be dictated by the antenatal findings. If the antenatal findings are not sufficient to justify a poor prognosis, then the fetus should be managed aggressively. This management should include weekly sonograms to monitor progression of the hydropic changes and frequent biophysical monitoring (nonstress test/fetal biophysical profile). Fetal paracentesis to decompress the fetal abdomen and allow for a vaginal delivery has been performed.24 In our department, we have done several paracentesis, but we would not recommend its routine use. Because hydropic fetuses are very vulnerable to the stress of labor and delivery, an elective preterm delivery, after documenting lung maturity, and liberal use of CS may be appropriate to improve the outcome of this group of infants.19
Utility of Treponemal Testing from Aqueous Fluid in the Diagnosis of Ocular Syphilis in Patients with HIV/AIDS
Published in Ocular Immunology and Inflammation, 2022
Nivedita Nair, Sridharan Sudharshan, Appakkudal R. Anand, Jyotirmay Biswas, K. Lily Therese
Medline search revealed that the present study is the first attempt to evaluate TPHA titers in aqueous humor. The main strength of this study is its novelty, ability to get positive test results from IO fluids corresponding to the serology values, easier testing method from aqueous sample, performing standardized and easily available laboratory tests such as RPR and TPHA and patient’s positive response to anti-syphilitic treatment. The limitations are those inherent to a retrospective study with small number of patients. Testing for follow-up titers from aqueous would have been ideal, but has obvious practical difficulties of testing from IO sample in an eye with resolved inflammation. Repeat testing can be considered in patients with persistent or recurrent inflammation despite treatment. Diagnostic paracentesis is a safe and simple out-patient procedure.26 None of our study patients had any procedure related adverse events.
Is there any relationship between massive ascites and elevated CA-125 in systemic lupus erythematosus? Case report and review of the literature
Published in Modern Rheumatology Case Reports, 2021
Elias Quintero-Muñoz, María Alejandra Gómez Pineda, Carolina Araque Parra, Camilo Alfonso Vallejo Castillo, Víctor Ortega Marrugo, Juan Bonilla Jassir, José Fernando Polo Nieto, Rafael Parra-Medina, Adriana Rojas-Villarraga
Massive ascites in the context of SLE is a rare manifestation that generates a major challenge due to the lack of diagnostic guidelines and the multiple entities that must be ruled out whether associated with SLE or not. Paracentesis should be done to establish the underlying cause. First, it is done to determine the presence of infection or portal hypertension and the SAAG. Aetiologies other than SLE such as liver disease, neoplasms, peritoneal infections and congestive heart failure should be ruled out [4]. Then, those that may or may not be related to SLE such as nephrotic syndrome, protein-losing enteropathy, restrictive pericarditis and Budd Chiari Syndrome can be identified. If all of the above are ruled out, then lupus peritonitis (acute or chronic) could be considered. The characteristics of the ascitic fluid in lupus peritonitis usually include a SAAG <1.1, a wide range of leukocytes (10–1630/mm3), and a range of fluid proteins of 34–47 mg/L (Figure 4) [5].
Cirrhosis, gastrointestinal bleed, and cryptococcal peritonitis
Published in Baylor University Medical Center Proceedings, 2020
Amy E. Barnett, Karen B. Brust
Our review resulted in 16 articles and 21 cases of cryptococcal peritonitis in HIV-negative patients (Table 1).1,5,6,8–20 Most patients were men (n = 14, 67%) with a median age of 54 years (range, 34–65). Alcohol abuse was the most common cause of underlying cirrhosis (n = 10, 48%), with or without concomitant viral hepatitis. Of the 21 cases, 8 (38%) involved patients who experienced upper gastrointestinal bleed (UGIB) within a month before presentation. Specific information regarding UGIB was not available for the other cases. Ascitic fluid analysis was universally abnormal and typically lymphocytic predominant. It took an average of 5 days from the time paracentesis was performed until culture results were available. About 50% of patients were concomitantly fungemic, and 8 patients had cryptococcal meningitis. Peritoneal fluid cryptococcal antigen (CrAg) testing was performed on only 4 patients, but all results were positive, ranging from 1:4 to 1:2048. Amphotericin B (with or without the use of flucytosine or fluconazole) was the primary treatment. Sixteen patients died. Mortality is estimated at 76%.