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Ascites

  • Transudate ddx (SAAG > 1.1)

    • portal hypertension (hepatomegaly): cirrhosis, CHF, hepatic vein obstruction, Budd Chiari, portal vein obstruction, IVC obstruction
    • hypoalbuminemia: nephrotic syndrome, protein-losing gastroenteropathy, malnutrition
    • Meigs syndrome: ovarian fibroma, ovarian cystadenoma
  • Exudate ddx (SAAG < 1.1)

    • inflammation: TB, peritonitis, pancreatitis, sarcoidosis
    • malignancy
    • other: pancreatic ascites, chylous ascites (malignancy, infection, trauma), AIDS
  • Labs

    • SAAG (initial lab)
    • UA
    • albumin
    • lipase, amylase
    • CXR
    • CT
  • SAAG = serum albumin - ascitic albumin

  • HPI

    • onset
    • severity
    • associated pains
  • ROS

    • fever, weight loss
    • cardio: chest pain, exertional dyspnea
    • pulm: cough, hemoptysis
    • GI: nausea, vomiting, diarrhea, abdominal pain
    • endo: hirsuitism
  • PMH

    • CHF
    • cirrhosis
    • TB
    • cancer
  • FH

    • ovarian cancer
  • SH

    • EtOH
  • Meds

  • Allergies

  • Px

    • vitals
    • gen impression
    • cardio: JVD
    • pulm
    • abd: percussion dullness, pain, mass, organomegaly

  • Print | Citations

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