1
|
Suter P, Duerig M, Haefliger E, Chuard C. Identification of Francisella tularensis in ascites in the context of typhoidal tularaemia. BMJ Case Rep 2024; 17:e256509. [PMID: 38553022 PMCID: PMC10982718 DOI: 10.1136/bcr-2023-256509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Tularaemia is a highly infectious, zoonotic disease caused by Francisella tularensis, which has become increasingly prevalent over the past decade. Depending on the route of infection, different clinical manifestations can be observed. We report a case of typhoidal tularaemia presenting as a febrile illness with gastrointestinal symptoms in a patient in her mid-80s. During the acute illness phase and in the context of alcohol-related liver cirrhosis, the patient developed progressive ascites. During paracentesis, spontaneous bacterial peritonitis was consistently reported. Blood culture revealed Gram-negative bacilli identified as F. tularensis upon microscopic examination. Immediate clinical improvement was observed after adaptation to a pathogen-specific antibiotic regime. Typhoidal tularaemia presents general, non-specific symptoms without the local manifestations seen in other forms of the disease, thus representing a diagnostic challenge. In the case of protracted fever and if the epidemiological context as well as possible exposure are compatible, tularaemia should be considered in the differential diagnosis.
Collapse
Affiliation(s)
- Philipp Suter
- Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Marco Duerig
- Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
- Division of Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Haefliger
- Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
- Division of Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Chuard
- Departement of Infectiology, University and Hospital of Fribourg, Fribourg, Switzerland
| |
Collapse
|
2
|
Bolia R, Srivastava A. Ascites and Chronic Liver Disease in Children. Indian J Pediatr 2024; 91:270-279. [PMID: 37310583 DOI: 10.1007/s12098-023-04596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/17/2023] [Indexed: 06/14/2023]
Abstract
Development of ascites in children with chronic liver disease is the most common form of decompensation. It is associated with a poor prognosis and increased risk of mortality. A diagnostic paracentesis should be performed in liver disease patients with- new-onset ascites, at the beginning of each hospital admission and when ascitic fluid infection (AFI) is suspected. The routine analysis includes cell count with differential, bacterial culture, ascitic fluid total protein and albumin. A serum albumin-ascitic fluid albumin gradient of ≥1.1 g/dL confirms the diagnosis of portal hypertension. Ascites has been reported in children with non-cirrhotic liver disease like acute viral hepatitis, acute liver failure and extrahepatic portal venous obstruction. The main steps in management of cirrhotic ascites include dietary sodium restriction, diuretics and large-volume paracentesis. Sodium should be restricted to maximum of 2 mEq/kg/d (max 90 mEq/d) of sodium/day. Oral diuretic therapy comprises of aldosterone antagonists (e.g., spironolactone) with or without loop-diuretics (e.g., furosemide). Once the ascites is mobilized, the diuretics should be gradually tapered to the minimum effective dosage. Tense ascites should be managed with a large-volume paracentesis (LVP) preferably with albumin infusion. Therapeutic options for refractory ascites include recurrent LVP, transjugular intrahepatic porto-systemic shunt and liver transplantation. AFI (fluid neutrophil count ≥250/mm3) is an important complication, and requires prompt antibiotic therapy. Hyponatremia, acute kidney injury, hepatic hydrothorax and hernias are the other complications.
Collapse
Affiliation(s)
- Rishi Bolia
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, 501, Stanley Street, South Brisbane, Queensland, 4101, Australia
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India.
| |
Collapse
|
3
|
Lan T, Chen M, Tang C, Deltenre P. Recent developments in the management of ascites in cirrhosis. United European Gastroenterol J 2024; 12:261-272. [PMID: 38340308 PMCID: PMC10954428 DOI: 10.1002/ueg2.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/05/2023] [Indexed: 02/12/2024] Open
Abstract
In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a long time in the management of portal hypertension may have beneficial effects that were not previously identified. Long-term albumin infusion may improve survival in patients with cirrhosis and ascites while beta-blockers may reduce ascites occurrence. Transjugular intrahepatic porto-systemic shunt (TIPS) placement may also improve survival in selected patients in addition to the control with ascites. Low-flow ascites pump insertion can be another option for some patients with intractable ascites. In this review, we summarize the latest data related to the management of ascites occurring in cirrhosis. There are still unanswered questions, such as the optimal use of albumin as a long-term therapy, the place of beta-blockers, and the best timing for TIPS placement to improve the natural history of ascites, as well as the optimal stent diameter to reduce the risk of shunt-related side-effects. These issued should be addressed in future studies.
Collapse
Affiliation(s)
- Tian Lan
- Lab of Gastroenterology and Hepatology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Chen
- Lab of Gastroenterology and Hepatology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Chengwei Tang
- Lab of Gastroenterology and Hepatology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Pierre Deltenre
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
- Department of Gastroenterology and Hepatology, Clinique St Luc, Bouge, Belgium
| |
Collapse
|
4
|
Vidyani A, Sibarani CI, Widodo B, Purbayu H, Thamrin H, Miftahussurur M, Setiawan PB, Sugihartono T, Kholili U, Maimunah U. Diagnosis and Management of Hepatic Hydrothorax. Korean J Gastroenterol 2024; 83:45-53. [PMID: 38389460 DOI: 10.4166/kjg.2023.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 02/24/2024]
Abstract
Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In most cases, hepatic hydrothorax is seen in patients with ascites. However, ascites is not always found at diagnosis and is not clinically detected in 20% of patients with hepatic hydrothorax. Some patients have no symptoms and incidental findings on radiologic examination lead to the diagnosis of the condition. In the majority of cases, the patients present with symptoms such as dyspnea at rest, cough, nausea, and pleuritic chest pain. The diagnosis of hepatic hydrothorax is based on clinical manifestations, radiological features, and thoracocentesis to exclude other etiologies such as infection (parapneumonic effusion, tuberculosis), malignancy (lymphoma, adenocarcinoma) and chylothorax. The management strategy involves a stepwise approach of one or more of the following: Reducing ascitic fluid production, preventing fluid transfer to the pleural space, fluid drainage from the pleural cavity, pleurodesis (obliteration of the pleural cavity), and liver transplantation. The complications of hepatic hydrothorax are associated with significant morbidity and mortality. The complication that causes the highest morbidity and mortality is spontaneous bacterial empyema (also called spontaneous bacterial pleuritis).
Collapse
Affiliation(s)
- Amie Vidyani
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Citra Indriani Sibarani
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Budi Widodo
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Herry Purbayu
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Husin Thamrin
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Muhammad Miftahussurur
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
- Helicobacter pylori and Mycrobiota Study Group, Institute Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Poernomo Boedi Setiawan
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Titong Sugihartono
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Ulfa Kholili
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| | - Ummi Maimunah
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr.Soetomo Teaching Hospital, Surabaya, Indonesia
| |
Collapse
|
5
|
Sbeit W, Maamoun B, Azzam S, Shahin A, Carmiel-Haggai M, Khoury T. Ascites fluid calprotectin level is highly accurate in diagnosing spontaneous bacterial peritonitis: a preliminary proof of concept prospective study. Clin Exp Med 2024; 24:25. [PMID: 38281236 PMCID: PMC10822801 DOI: 10.1007/s10238-023-01257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
Ascites is the most common complication of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is a common complication of ascites. The diagnosis is made by an ascitic fluid polymorphonuclear (PMN) cell count of ≥ 250/mm3. However, no other diagnostic test is present for the diagnosis of SBP. The aim of the study present study is to assess the diagnostic yield of ascitic calprotectin in SBP, and to explore whether it can predict disease stage. We performed a single center proof-of-concept prospective study including all patients with cirrhosis and ascites who underwent paracentesis. Overall, 31 patients were included in the study. Eight patients had SBP vs. 23 patients without SBP. Ascitic calprotectin level was 77.4 ± 86.5 μg/mL in the SBP group, as compared to 16.1 ± 5.6 μg/mL in the non-SBP group (P = 0.001). An ascitic calprotectin cut-off value of > 21 μg/mL was associated with sensitivity and specificity of 85.7% and 89.5%, respectively, with ROC of 0.947 (95% CI 0.783 to 0.997, P < 0.0001). Notably, ascitic calprotectin did not had a prognostic value in cirrhosis stage and prognosis. Ascitic calprotectin was highly accurate in the diagnosis of SBP. It can be a serve as adjunct for indefinite cases of SBP.
Collapse
Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
| | - Basheer Maamoun
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
| | - Subhi Azzam
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
| | - Amir Shahin
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
| | - Michal Carmiel-Haggai
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel
- Liver Unit, Galilee Medical Center, Nahariya, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel.
| |
Collapse
|
6
|
Ge Z, Wang K, Zhang Z, Zhang X, Sun P, Chen N, Tan Y, Shen T, Dai H, Li W. Successful treatment of refractory ascites in a patient with liver cirrhosis combined with hepatic artery-portal vein malformation: A case report. Medicine (Baltimore) 2024; 103:e36886. [PMID: 38277566 PMCID: PMC10817139 DOI: 10.1097/md.0000000000036886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION Hepatic artery-portal vein malformation is rarely encountered in clinical practice. Here, we reported a case of liver cirrhosis combined with hepatic artery-portal vein malformation with refractory ascites as the main symptom. And it was successfully treated by us. The present case demonstrates the role of hepatic artery-portal vein malformation in cirrhotic ascites and the importance of early diagnosis and interventional treatment. This article may provides some experience for the treatment of such patients. PATIENT CONCERNS The patient was a 72-year-old woman with a 40-year history of Hepatitis B virus surface antigen positivity who sought medical advice with a chief complaint of abdominal distension for 1 week. DIAGNOSES Enhanced abdominal computed tomography imaging of this patient revealed liver cirrhosis, splenomegaly, esophageal and gastric varices, massive ascites, and a low-density area in the S4 segment of the liver with an ambiguous boundary. Widening of the left branch of the portal vein was evident, and the portal vein was highlighted in the arterial phase and the venous phase. Digital subtraction angiography revealed substantial thickening of the left hepatic artery, and the administered contrast agent drained through the malformed vascular mass to the thickened left portal vein. Liver cirrhosis combined with hepatic artery-portal vein malformation were diagnosed. And we considered that the artery-portal vein malformation in this patient might be caused by cirrhosis. INTERVENTIONS The patient was applied diuretics, entecavir and transcatheter embolization. OUTCOMES The patient ascites did not resolve significantly when treated with diuretics alone. After the transcatheter embolization, the patient ascites relieved remarkably. CONCLUSION The patient underwent transcatheter embolization for hepatic artery-portal vein malformation, after which her ascites resolved with good short-term curative efficacy. So, the patients who suffered from liver cirrhosis combined with hepatic artery-portal vein malformation and refractory ascites, should be active on transcatheter embolization.
Collapse
Affiliation(s)
- Zhenyu Ge
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Kai Wang
- Department Vascular intervention, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Zhaomei Zhang
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Xiaoqian Zhang
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Peng Sun
- Department Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Ning Chen
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Yang Tan
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Tingting Shen
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Hongsheng Dai
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Wenwen Li
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| |
Collapse
|
7
|
Ahmed U, Chughtai N. Endometriosis presenting as relapsing haemorrhagic ascites in a South Asian woman: A case report. J PAK MED ASSOC 2024; 74:165-168. [PMID: 38219192 DOI: 10.47391/jpma.9438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Endometriosis presenting as ascites is a rare entity, and is more so in women of Asian ethnicity. Less than a hundred cases have been reported worldwide. Majority of patients present with abdominal dist ension and pa in, drai ning massive blood stained serosanguineous fluid. This hinders future fertility prospects of these women. O va rian suppression has been employed as a successful treatment, followed by definitive surgical treatment, such as bilateral salpingo -ooph orectomy, to end the possibility of recurrences, which are otherwise always possible. We present the case of a woman of reproductive age, seeking fertility treatment, who had a more subtle presentation of moderate, but relapsing ascites of un known origin in the past two years. Diagnostic laparoscopy and histopathology of the pe ritoneal deposits suggested endometriosis. Her ovarian func tion was s uppressed, and sh e is curre nt ly underway of a ssisted re produ ction for achieving a pregnancy.
Collapse
Affiliation(s)
- Ushna Ahmed
- Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
| | - Novera Chughtai
- Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
8
|
Tan Q, Xu LF, Yan T, Huang CH, Tao Y, Huang WH, Yu SL. Deciphering the puzzle: a case report of Tjalma syndrome (pseudo-pseudo Meigs' syndrome) with profoundly elevated CA-125 and pleural effusion. Front Immunol 2023; 14:1277683. [PMID: 38162662 PMCID: PMC10756667 DOI: 10.3389/fimmu.2023.1277683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Elevated CA-125 levels, polyserous effusions (such as pleural effusion, ascites, etc.) in young women with systemic lupus erythematosus (SLE) may signal pseudo-pseudo Meigs' syndrome (PPMS), after excluding other causes. We describe a 32-year-old SLE patient with recurrent bilateral pleural effusions and unexplained hypercalcemia for 10 months. Extensive evaluations revealed no infections or tumors. Cytokine analysis showed elevated interleukin (IL) levels, especially IL-6 in pleural effusion. Treatment with immunosuppressive therapy resulted in reduced cancer antigen (CA) 125 levels and decreased effusion volume, demonstrating a positive response to intervention in this case of PPMS.
Collapse
Affiliation(s)
- Qing Tan
- Department of Rheumatology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li Feng Xu
- Department of Cardiology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ting Yan
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Cheng Hui Huang
- Department of Rheumatology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yi Tao
- Department of Rheumatology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wen Hui Huang
- Department of Rheumatology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shui Lian Yu
- Department of Rheumatology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
9
|
Lavigne JM, Thompson RJ, Short M. Cirrhotic ascites masquerading as haemoperitoneum in paediatric trauma: The diagnostic dilemma. Emerg Med Australas 2023; 35:1047-1048. [PMID: 37666653 DOI: 10.1111/1742-6723.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/18/2022] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Jordan M Lavigne
- Department of Paediatric Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Richard J Thompson
- Department of Paediatric Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Melissa Short
- Department of Paediatric Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| |
Collapse
|
10
|
Kobayashi Y, Ozawa N, Yoshida T, Minowa T, Michinaga Y, Inui K, Hashimoto K, Kamijo Y. Novel and highly reliable leak check tests for drop- and external pressure-type cell-free and concentrated ascites reinfusion therapy. Ther Apher Dial 2023; 27:1040-1047. [PMID: 37594000 DOI: 10.1111/1744-9987.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/30/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION For safe management of cell-free and concentrated ascites reinfusion therapy (CART), a highly reliable leak test for detecting ascites filter damage is essential. However, such a test has not been established for drop-type CART. METHODS We devised two novel leak tests for drop- and external pressure-type CART, manual or pump pressurization methods, using high-pressure loading and pressure monitoring, and investigated their reliability. RESULTS Both methods could easily load and maintain sufficiently high pressure (>400 Torr) on the hollow fibers for 2 min. No result deviation was noted between different operators. The pressure drops in both methods were identical and significantly lower than those in the leak test using a special CART machine, the e-CART. CONCLUSION The reliability of our revised leak test is equivalent to that of the automatic leak test of e-CART. These highly reliable leak tests may contribute to safety in patients undergoing drop- and external pressure-type CART.
Collapse
Affiliation(s)
- Yasuko Kobayashi
- Department of Clinical Engineering, Shinshu University Hospital, Matsumoto, Nagano, Japan
- Division of Blood Purification, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Nana Ozawa
- Department of Clinical Engineering, Shinshu University Hospital, Matsumoto, Nagano, Japan
- Division of Blood Purification, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Tamami Yoshida
- Department of Clinical Engineering, Shinshu University Hospital, Matsumoto, Nagano, Japan
- Division of Blood Purification, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Takashi Minowa
- Department of Clinical Engineering, Shinshu University Hospital, Matsumoto, Nagano, Japan
- Division of Blood Purification, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Yuki Michinaga
- Department of Clinical Engineering, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Keita Inui
- Division of Blood Purification, Shinshu University Hospital, Matsumoto, Nagano, Japan
- Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yuji Kamijo
- Division of Blood Purification, Shinshu University Hospital, Matsumoto, Nagano, Japan
- Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| |
Collapse
|
11
|
Abstract
ABSTRACT Patients with cirrhosis have a 50% to 60% chance of developing ascites within 10 years of diagnosis. Once ascites has developed, patients have a predicted 50% mortality within 3 years. This article discusses the pathophysiology of ascites caused by cirrhosis, standards in diagnosing ascites, and the recommendations and guidelines for treating ascites. Properly managing patients with decompensated cirrhosis can improve their quality of life and longevity and minimize additional complications.
Collapse
Affiliation(s)
- J Kyle Jack
- J. Kyle Jack is a student in the doctor of medical science program at A.T. Still University's Arizona School of Health Sciences in Mesa, Ariz., and practices in radiology at Enloe Medical Center in Chico, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
12
|
Malick M, Shahid W, Lateef A, Zubair Z, Zaidi SM. Hepatic Hydrothorax Without Ascites: A Diagnostic And Management Challenge. J Ayub Med Coll Abbottabad 2023; 35(Suppl 1):S801-S803. [PMID: 38406913 DOI: 10.55519/jamc-s4-12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Hepatic hydrothorax refers to the presence of a pleural effusion (usually >500 mL) in a patient with cirrhosis who does not have other reasons to have a pleural effusion (e.g., cardiac, pulmonary, or pleural disease). Hepatic hydrothorax occurs in approximately 5-6% of patients with cirrhosis. It results from the ascitic fluid draining into the pleural cavity through the diaphragmatic defects. The presentation of patients with hepatic hydrothorax includes chest pain, hypoxemia, cough, shortness of breath and fatigue. The atypical feature, in this case, is the presence of hepatic hydrothorax in a patient with chronic liver disease without ascites. The management of hepatic hydrothorax is difficult. The initial treatment should be a low-salt diet plus diuretics. The best diuretic regimen is probably the combination of furosemide and spironolactone. However, about 25% of patients are refractory to this regimen, and additional therapy is indicated. This patient underwent thoracentesis, however, considering the re-accumulation of fluid, a pigtail catheter was placed which drained up to 8 liters of fluid.
Collapse
Affiliation(s)
- Maria Malick
- Department of Medicine, Patel Hospital, Karachi, Pakistan
| | - Wajeeha Shahid
- Department of Medicine, Patel Hospital, Karachi, Pakistan
| | - Anum Lateef
- Department of Medicine, Patel Hospital, Karachi, Pakistan
| | | | | |
Collapse
|
13
|
Kalluri S, Gonzalez SA, Wolfshohl J. Après Moi, Le Deluge: The identification and management of flood syndrome in the emergency department. Am J Emerg Med 2023; 72:223.e5-223.e6. [PMID: 37517872 DOI: 10.1016/j.ajem.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023] Open
Abstract
Umbilical hernias develop in approximately 20% of patients with liver cirrhosis and ascites. Flood Syndrome is an eponym describing the spontaneous rupture of these umbilical hernias due to the elevated intrabdominal pressure associated with large-volume ascites. Though rare, Flood Syndrome is associated with several life-threatening sequela including infection, organ failure, and hypovolemic shock, leading to mortality or transplant in over 30% of patients. The following case is a single patient encounter describing an 80-year-old female with long-standing ascites who presented to the Emergency Department shortly after experiencing a spontaneous extravasation of fluid from her umbilical hernia.
Collapse
Affiliation(s)
- Sneha Kalluri
- Department of Medicine, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America.
| | - Stevan A Gonzalez
- Department of Medicine, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America; Division of Hepatology, Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott & White All-Saints Medical Center, Fort Worth, TX, United States of America
| |
Collapse
|
14
|
Lei Y, Guo Q, Liu J, Huang H, Han P. Staphylococcus cohnii infection diagnosed by metagenomic next generation sequencing in a patient on hemodialysis with cirrhotic ascites: a case report. Front Cell Infect Microbiol 2023; 13:1240283. [PMID: 37808911 PMCID: PMC10556727 DOI: 10.3389/fcimb.2023.1240283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Patients with spontaneous bacterial peritonitis (SBP) often just receive empirical antibiotic therapy, as pathogens can be identified in only few patients using the techniques of conventional culture. Metagenomic next generation sequencing (mNGS) is a useful tool for diagnosis of infectious diseases. However, clinical application of mNGS in diagnosis of infected ascites of cirrhotic patients is rarely reported. Case presentation A 53-year-old male with cirrhosis on regular hemodialysis presented with continuous abdominal pain. After treatment with empiric antibiotics, his inflammatory parameters decreased without significant relief of abdominal pain. Finally, based on ascites mNGS detection, he was diagnosed as infection of Staphylococcus cohnii (S.cohnii), a gram-positive opportunistic pathogen. With targeted antibiotic treatment, the bacterial peritonitis was greatly improved and the patient's abdominal pain was significantly alleviated. Conclusions When conventional laboratory diagnostic methods and empirical antibiotic therapy fail, proper application of mNGS can help identify pathogens and significantly improve prognosis and patients' symptoms.
Collapse
Affiliation(s)
| | | | | | - Huanjun Huang
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Han
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
15
|
Tonon M, Gagliardi R, Piano S. Don't delay: Early paracentesis can save lives in hospitalized patients with cirrhosis and ascites. Liver Transpl 2023; 29:911-912. [PMID: 37162148 DOI: 10.1097/lvt.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Marta Tonon
- Department of Medicine, Unit of Internal Medicine and Hepatology, University of Padova, Padova, Italy
| | | | | |
Collapse
|
16
|
Claus S, Brozat JF, Trautwein C, Koch A. [Cost-efficiency of ascites treatment in the G-DRG system]. Z Gastroenterol 2023; 61:1197-1206. [PMID: 36130616 DOI: 10.1055/a-1909-2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In Germany, around 1,000,000 people are affected by cirrhosis of the liver, with ascites being a common consequence. Hospitals are caught between the opposing aims of profitability and patient-centered treatment as a result of the increasing compression of services in hospitals and the increasing economization in the healthcare sector. Treatment costs are a crucial starting point for optimizing success and the optimal use of resources, given the restricted revenue flexibility due to established flat charges per case. The goal of this study is to examine the exact cost and income structures for ascites therapy at a university hospital that specializes in liver diseases. The treatment data of 778 patients admitted to the University Hospital Aachen's Department of Internal Medicine III between 2016 and 2019 were retrospectively and anonymously evaluated for this study. The revenue shares of the matrix of cost centers and cost types of the German Diagnosis-Related Groups (G-DRG) system were compared to the revenue shares of the specified services in the context of activity-based costing. Inadequate refinancing was discovered in every area of the therapy process that was investigated. As a result, the treatment of ascites in cirrhosis is currently underrepresented in the DRG system. This is owing to the fact that patients treated at the university hospital have a greater case severity.
Collapse
Affiliation(s)
- Simone Claus
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Germany
| | | | | | - Alexander Koch
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Germany
| |
Collapse
|
17
|
Jiang R, Huang Y, Zeng M, Xing C, Mao H, Wu B. A marked elevation in serum creatinine/cystatin C ratio may indicate pseudo-acute kidney injury due to urinary ascites: a case report and literature review. BMC Nephrol 2023; 24:243. [PMID: 37605159 PMCID: PMC10441709 DOI: 10.1186/s12882-023-03289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Urinary ascites represents a scarcely observed pseudo-acute kidney injury in clinical settings. Protracted or missed diagnosis may hold grave ramifications for patient outcomes. CASE PRESENTATION We reported a case involving an elderly female patient experiencing pseudo-acute kidney injury accompanied by ascites, wherein her renal dysfunction persisted despite medical intervention and hemodialysis. Urinary ascites was identified via a methylene blue test and by contrasting creatinine levels in serum and ascites. This patient's kidney function was multiple typified by a marked elevation in serum creatinine/Cystatin C ratio (> 2 L/dL), potentially serving as a clue for the clinical diagnosis of pseudo-acute kidney injury engendered by urinary ascites. CONCLUSIONS This case suggested the potential diagnostic value of an asynchronous increase in serum creatinine and serum CysC (or an increased ratio of blood creatinine to blood CysC) in patients with pseudo-acute kidney injury.
Collapse
Affiliation(s)
- Ran Jiang
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yumin Huang
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ming Zeng
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Changying Xing
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Huijuan Mao
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Buyun Wu
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| |
Collapse
|
18
|
Chinese Society of Hepatology, Chinese Medical Association. [Guidelines on the management of ascites in cirrhosis (2023 version)]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:813-26. [PMID: 37723063 DOI: 10.3760/cma.j.cn501113-20230719-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Chinese Society of Hepatology of Chinese Medical Association organized relevant experts to update the Guidelines on the management of ascites and complications in cirrhosis in 2017 and renamed it as Guidelines on the management of ascites in cirrhosis. It provides guiding recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS).
Collapse
|
19
|
Pereira RA, Virella D, Perdigoto R, Marcelino P, Saliba F, Germano N. Continuous passive paracentesis versus large-volume paracentesis in the prevention and treatment of intra-abdominal hypertension in the critically ill cirrhotic patient with ascites (COPPTRIAHL): study protocol for a randomized controlled trial. Trials 2023; 24:534. [PMID: 37582719 PMCID: PMC10426145 DOI: 10.1186/s13063-023-07541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Critically ill patients with cirrhosis and ascites are at high risk for intra-abdominal hypertension (IAH) which increases mortality. Clinical guidelines recommend maintaining intra-abdominal pressure (IAP) below 16 mmHg; nonetheless, more than three quarters of critically ill patients with cirrhosis develop IAH during their first week of ICU stay. Standard-of-care intermittent large-volume paracentesis (LVP) relieves abdominal wall tension, reduces IAP, optimizes abdominal perfusion pressure, and is associated with short-term improvement in renal and pulmonary dysfunction. However, there is no evidence of the superiority of different paracentesis strategies in the prevention and treatment of IAH in critically ill patients with cirrhosis. This trial aims to compare the outcomes of continuous passive paracentesis versus LVP in the prevention and treatment of IAH in patients with cirrhosis and ascites. METHODS An investigator-initiated, open label, randomized controlled trial, set in a general ICU specialized in liver disease, was initiated in August 2022, with an expected duration of 36 months. Seventy patients with cirrhosis and ascites will be randomly assigned, in a 1:1 ratio, to receive one of two methods of therapeutic paracentesis. A stratified randomization method, with maximum creatinine and IAP values as strata, will homogenize patient baseline characteristics before trial group allocation, within 24 h of admission. In the control group, LVP will be performed intermittently according to clinical practice, with a maximum duration of 8 h, while, in the intervention group, continuous passive paracentesis will drain ascitic fluid for up to 7 days. The primary endpoint is serum creatinine concentration, and secondary endpoints include IAP, measured creatinine clearance, daily urine output, stage 3 acute kidney injury and multiorgan dysfunction assessed at day 7 after enrollment, as well as 28-day mortality rate and renal replacement therapy-free days, and length-of-stay. Prespecified values will be used in case of renal replacement therapy or, beforehand ICU discharge, liver transplant and death. Safety analysis will include paracentesis-related complication rate and harm. Data will be analyzed with an intention-to-treat approach. DISCUSSION This is the first trial to compare the impact of different therapeutic paracentesis strategies on organ dysfunction and outcomes in the prevention and treatment of IAH in critically ill patients with cirrhosis and ascites. TRIAL REGISTRATION ClinicalTrials.gov NCT04322201 . Registered on 20 December 2019.
Collapse
Affiliation(s)
- Rui Antunes Pereira
- Unidade de Cuidados Intensivos Polivalente 7, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Daniel Virella
- Unidade Funcional de Neonatologia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Rui Perdigoto
- Unidade de Transplante, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central; Nova Medical School, Lisboa, Portugal
| | - Paulo Marcelino
- Unidade de Cuidados Intensivos Polivalente 4, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Faouzi Saliba
- Hôpital Paul Brousse, Hepato-Biliary Center, Université Paris Saclay, INSERM Unit 1193, Villejuif, France
| | - Nuno Germano
- Unidade de Cuidados Intensivos Polivalente 7, Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| |
Collapse
|
20
|
Chai L, Li Z, Wang T, Wang R, Pinyopornpanish K, Cheng G, Qi X. Efficacy and safety of tolvaptan in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Gastroenterol Hepatol 2023; 17:1041-1051. [PMID: 37794713 DOI: 10.1080/17474124.2023.2267421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIMS Tolvaptan has been approved for the management of cirrhosis-related complications according to the Japanese and Chinese practice guidelines, but not the European or American practice guidelines in view of FDA warning about its hepatotoxicity. This study aimed to systematically evaluate its efficacy and safety in cirrhosis. METHODS The PubMed, EMBASE, and Cochrane library databases were searched to identify randomized controlled trials (RCTs) evaluating the efficacy and/or safety of tolvaptan in cirrhosis. Risk ratios (RRs) and weight mean differences (WMDs) were calculated. The incidence of common adverse events (AEs) was pooled. RESULTS Eight RCTs were included. Tolvaptan was significantly associated with higher rates of improvement of ascites (RR = 1.49, P < 0.001) and hyponatremia (RR = 1.80, P = 0.005) and incidence of any AEs (RR = 1.18, P = 0.003), but not serious AEs (RR = 0.86, P = 0.410). Tolvaptan was significantly associated with reductions in body weight (WMD = -1.30 kg, P < 0.001) and abdominal circumference (WMD = -1.71 cm, P < 0.001), and increases in daily urine volume (WMD = 1299.84 mL, P < 0.001) and serum sodium concentration (WMD = 2.57 mmol/L, P < 0.001). The pooled incidences of dry mouth, thirst, constipation, and pollakiuria were 16%, 24%, 6%, and 17%, respectively. CONCLUSION Short-term use of tolvaptan may be considered in cirrhotic patients with ascites who have inadequate response to conventional diuretics and those with hyponatremia.
Collapse
Affiliation(s)
- Lu Chai
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- NMPA Key Laboratory for Research and Evaluation of Drug Regulatory Technology, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhe Li
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- NMPA Key Laboratory for Research and Evaluation of Drug Regulatory Technology, Shenyang Pharmaceutical University, Shenyang, China
| | - Ting Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- NMPA Key Laboratory for Research and Evaluation of Drug Regulatory Technology, Shenyang Pharmaceutical University, Shenyang, China
| | - Ran Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Kanokwan Pinyopornpanish
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Gang Cheng
- NMPA Key Laboratory for Research and Evaluation of Drug Regulatory Technology, Shenyang Pharmaceutical University, Shenyang, China
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- NMPA Key Laboratory for Research and Evaluation of Drug Regulatory Technology, Shenyang Pharmaceutical University, Shenyang, China
| |
Collapse
|
21
|
Quanungo H, Quanungo H, Naderzad E, Venter F, Deemer E, Petersen G, Ragland A. A Rare Hemorrhagic, Orange-Colored Ascites, Challenging Traditional Ascitic Fluid Analysis. J Investig Med High Impact Case Rep 2023; 11:23247096221150630. [PMID: 36691914 PMCID: PMC9880565 DOI: 10.1177/23247096221150630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/25/2023] Open
Abstract
Analysis of ascitic fluid can offer useful information in developing and supporting a differential diagnosis. As one of the most prevalent complications in patients with cirrhosis, ascitic fluid aids in differentiating a benign condition from malignancy. Both the gross appearance of the ascitic fluid, along with fluid analysis, play a major role in diagnosis. Here, we discuss a patient with liver cirrhosis, esophageal varices, hepatitis C, and alcohol abuse, who had a paracentesis performed, which revealed a turbid, viscous, orange-colored ascitic fluid that has not been documented in literature. Ascitic fluid is routinely analyzed based on gross appearance, cell count, and serum ascites albumin gradient (SAAG) score. An appearance of turbidity or cloudiness has commonly suggested an inflammatory process. In our case, fluid analysis revealed a red blood cell count of 24 250/mcL, further suggesting inflammation. However, it also revealed an insignificant number of inflammatory cells, with a total nucleated cell count of 14/mcL. This rich-orange color has posed a challenge in classification and diagnosis of the underlying cause of ascites, with one classification system suggesting inflammation, while another suggesting portal hypertension. Furthermore, we have traditionally relied on the SAAG score to aid in determining portal hypertension as an underlying cause of ascites. With a 96.7% accuracy rate, the SAAG score incorrectly diagnosed portal hypertension in this patient. In this article, we aim to explore how this rare, orange-colored ascitic fluid has challenged the traditional classification system of ascites.
Collapse
Affiliation(s)
- Huma Quanungo
- University of California, Los Angeles,
USA
- Kern Medical, Bakersfield, California,
USA
| | - Huda Quanungo
- University of California, Los Angeles,
USA
- Kern Medical, Bakersfield, California,
USA
| | - Elena Naderzad
- University of California, Los Angeles,
USA
- Kern Medical, Bakersfield, California,
USA
| | - Frederick Venter
- University of California, Los Angeles,
USA
- Kern Medical, Bakersfield, California,
USA
| | - Elaine Deemer
- University of California, Los Angeles,
USA
- Kern Medical, Bakersfield, California,
USA
| | - Greti Petersen
- University of California, Los Angeles,
USA
- Kern Medical, Bakersfield, California,
USA
| | - Alan Ragland
- University of California, Los Angeles,
USA
- Kern Medical, Bakersfield, California,
USA
| |
Collapse
|
22
|
Liu G, Wang L, Li X, Zhang Y, Long H, Wang Y, Gao H, Xia H, Qian S. The value of next-generation metagenomic sequencing in pathogen detection of pleural effusions and ascites from children with sepsis. Front Cell Infect Microbiol 2023; 13:1130483. [PMID: 36891155 PMCID: PMC9986937 DOI: 10.3389/fcimb.2023.1130483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
Objective To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) using pleural effusion and ascites from children with sepsis. Methods In this study, children with sepsis or severe sepsis and appeared pleural or peritoneal effusions were enrolled, of whom the pleural effusions or ascites and blood samples were conducted pathogen detection using both conventional and mNGS methods. The samples were divided into pathogen-consistent and pathogen-inconsistent groups based on the consistency of mNGS results from different sample types, and into exudate and transudate groups based on their pleural effusion and ascites properties. The pathogen positive rates, pathogen spectrum, consistency between different sample types, and clinical diagnosis consistency were compared between mNGS and conventional pathogen tests. Results A total of 42 pleural effusions or ascites and 50 other type samples were collected from 32 children. The pathogen positive rate of the mNGS test was significantly higher than that of traditional methods (78.57% vs. 14.29%, P < 0.001) in pleural effusion and ascites samples, with a consistent rate of 66.67% between the two methods. Nearly 78.79% (26/33) of mNGS positive results of the pleural effusions and ascites samples were consistent with clinical evaluation, and 81.82% (27/33) of these positive samples reported 1-3 pathogens. The pathogen-consistent group outperformed the pathogen-inconsistent group in terms of consistency with respect to clinical evaluation (88.46% vs. 57.14%, P = 0.093), while there was no significant difference between the exudate and transudate groups (66.67% vs. 50.00%, P = 0.483). Conclusion Compared to conventional methods, mNGS has great advantages in pathogen detection of pleural effusion and ascites samples. Moreover, consistent results of mNGS tests with different sample types provide more reference values in clinical diagnosis.
Collapse
Affiliation(s)
- Gang Liu
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Lijuan Wang
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xuming Li
- Department of scientific affairs, HugoBiotech Co., Ltd., Beijing, China
| | - Ye Zhang
- Department of scientific affairs, HugoBiotech Co., Ltd., Beijing, China
| | - Hu Long
- Department of scientific affairs, HugoBiotech Co., Ltd., Beijing, China
| | - Yi Wang
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Hengmiao Gao
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Han Xia
- Department of scientific affairs, HugoBiotech Co., Ltd., Beijing, China
- *Correspondence: Suyun Qian, ; Han Xia,
| | - Suyun Qian
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- *Correspondence: Suyun Qian, ; Han Xia,
| |
Collapse
|
23
|
Köhler F, Wiegering A. [54/m-Mucinous ascites : Preparation for the medical specialist examination: part 16]. Chirurgie (Heidelb) 2022; 93:71-74. [PMID: 36053320 DOI: 10.1007/s00104-022-01712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Affiliation(s)
- F Köhler
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
| | - A Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland
| |
Collapse
|
24
|
Subhani M, Sheth A, Palaniyappan N, Sugathan P, Wilkes EA, Aithal GP. Diagnostic accuracy of serum ascites albumin gradient (SAAG) in a contemporary unselected medical cohort. J Int Med Res 2022; 50:3000605221140310. [PMID: 36448611 PMCID: PMC9716612 DOI: 10.1177/03000605221140310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe the different aetiologies of ascites and test the validity of serum ascites albumin gradient (SAAG) and cytology in a contemporary unselected medical cohort. METHODS All adult patients admitted to Nottingham University Hospitals, UK, between 1 May 2013 and 30 April 2018 with new-onset radiologically-confirmed ascites were included. Data were analysed to determine the distribution of different aetiologies of ascites and the diagnostic accuracy of SAAG in portal hypertension and cytology in malignancy as underlying causes of ascites. RESULTS Over 5 years, 286 patients presented with new-onset ascites; 122 surgical cases were excluded. Most patients were men (n = 84, 51.2%) over 50 years of age (n = 142, 86.6%). Cirrhosis accounted for 54.9% (n = 90) of the cases of ascites followed by malignancy (n = 48, 29.3%) and cardiac failure (n = 10, 6.1%). SAAG ≥11 g/L had a sensitivity of 85.5% and specificity of 60.6% for diagnosing portal hypertension as a cause of ascites (diagnostic accuracy = 78.5%, 95% confidence interval (CI): 69.8-85.5; area under the curve (AUC) = 0.756, 95% CI: 0.652-0.860). Ascitic fluid cytology was positive in 50% of malignant cases and 66% of primary peritoneal carcinomatosis cases. CONCLUSION The underlying aetiology and the validity of available tests varied substantially compared with previous reports.
Collapse
Affiliation(s)
- Mohsan Subhani
- Nottingham Digestive Diseases Centre (NDDC), Translation Medical Sciences, School of Medicine, University of Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Mohsan Subhani, NDDC BRU E Floor, QMC Nottingham, UK NG7 2UH.
| | - Abhishek Sheth
- Nottingham Digestive Diseases Centre (NDDC), Translation Medical Sciences, School of Medicine, University of Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Naaventhan Palaniyappan
- Nottingham Digestive Diseases Centre (NDDC), Translation Medical Sciences, School of Medicine, University of Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Peuish Sugathan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Emilie A Wilkes
- Nottingham Digestive Diseases Centre (NDDC), Translation Medical Sciences, School of Medicine, University of Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre (NDDC), Translation Medical Sciences, School of Medicine, University of Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| |
Collapse
|
25
|
Goh ZNL, Teo RYL, Chung BK, Wong AC, Seak CJ. At the heart of the problem: congestive cardiac failure as a cause of ascites: A narrative review. Medicine (Baltimore) 2022; 101:e29951. [PMID: 35945724 PMCID: PMC9351856 DOI: 10.1097/md.0000000000029951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Heart failure leading to cardiac ascites is an extremely rare and underrecognized entity in clinical practice. Recognizing cardiac ascites can be difficult, especially since patients presenting with ascites may have more than 1 etiology. Various biomarkers are available to aid in the diagnosis of cardiac ascites, though with differing sensitivities and specificities. Such biomarkers include serum albumin, ascitic albumin and protein, as well as serum N-terminal pro-brain natriuretic peptide (NT-proBNP). While serum NT-proBNP is a powerful biomarker in distinguishing the etiology of ascites and monitoring treatment progression, its cost can be prohibitive in low-resource settings. Clinicians practicing under these circumstances may opt to rely on other parameters to manage their patients. We go on further to report a series of 3 patients with cardiac ascites to illustrate how these biomarkers may be employed in the management of this patient population. Clinicians should always keep in mind the differential diagnosis of cardiac failure as a cause of ascites. The resolution of cardiac ascites may serve as a surrogate clinical marker for response to antifailure therapy in lieu of NT-proBNP at resource-scarce centers.
Collapse
Affiliation(s)
- Zhong Ning Leonard Goh
- Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Roland Yii Lin Teo
- Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Bui Khiong Chung
- Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Alexis Ching Wong
- Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Chen-June Seak
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Chen-June Seak, Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, No.6, Sec 2, Jincheng Road, Tucheng Dist., New Taipei City 236017, Taiwan, R.O.C. (ext. 5235/ / e-mail: )
| |
Collapse
|
26
|
Kusaka K, Nakano K, Fukuyo S, Miyazaki Y, Matsunaga S, Tanaka Y. A case of mixed connective tissue disease complicated by pulmonary hypertension and ascites after addition of pulmonary vasodilators. Mod Rheumatol Case Rep 2022; 6:203-208. [PMID: 35274731 DOI: 10.1093/mrcr/rxac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
We present the case of a 54-year-old woman with a long history of pulmonary hypertension associated with mixed connective tissue disease. She was being treated with pulmonary vasodilators, including epoprostenol and bosetan, but her mean pulmonary arterial pressure (mPAP) gradually worsened. Although her mPAP began to improve with adding sildenafil, ascites occurred. Discontinuing newly initiated drugs and starting diuretics improved her ascites. This suggested that an intensification of the treatment with vasodilators might have led to ascites (on a background of a probable arteriovenous shunt formation) in this patient with a long history of pulmonary hypertension.
Collapse
Affiliation(s)
- Katsuhide Kusaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuhisa Nakano
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Shunsuke Fukuyo
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yusuke Miyazaki
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satsuki Matsunaga
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| |
Collapse
|
27
|
Baiges A, Hernández-Gea V. Management of Liver Decompensation in Advanced Chronic Liver Disease: Ascites, Hyponatremia, and Gastroesophageal Variceal Bleeding. Clin Drug Investig 2022; 42:25-31. [PMID: 35476218 PMCID: PMC9205794 DOI: 10.1007/s40261-022-01147-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 12/26/2022]
Abstract
Portal hypertension is a major complication of cirrhosis characterized by a pathological hepatic venous pressure gradient (HVPG) ≥ 5 mmHg. The structural changes observed in the liver leading to intrahepatic vascular resistance and, consequently, portal hypertension appear in the early stages of cirrhosis. Clinically significant portal hypertension (HVPG ≥ 10 mmHg) is associated with several clinical consequences, such as ascites, hyponatremia, gastroesophageal variceal bleeding, hepatorenal syndrome, cardiopulmonary complications, adrenal insufficiency, and hepatic encephalopathy. The diagnosis and management of these complications depend on their early identification and treatment. Regarding ascites, diuretics are a useful treatment, although plasma sodium levels must be properly controlled to avoid hyponatremia. The management of hypovolemic hyponatremia usually consists in stopping diuretics and the administration of volume. On the contrary, hypervolemic hyponatremia is managed with fluid and sodium restriction. Transjugular intrahepatic portosystemic shunt (TIPS) should be considered in patients with refractory ascites. Primary prophylaxis of variceal bleeding should be based mainly on non-selective beta-blockers. Management of acute gastroesophageal variceal bleeding includes vasoactive drugs and endoscopic band ligation and, in patients at high risk of failure and rebleeding, preemptive use of TIPS. Secondary prophylaxis with a combination of non-selective beta-blockers and endoscopic band ligation is the treatment of choice. This article focuses on the management of ascites, hyponatremia, and gastroesophageal variceal bleeding.
Collapse
Affiliation(s)
- Anna Baiges
- Servicio de Hepatología, Hemodinámica Hepática. Hospital Clínic, Barcelona, Spain.
| | | |
Collapse
|
28
|
Das A, Mead P, Mala HR. Abdominal tuberculosis masquerading as ovarian carcinoma in a Caucasian woman: a diagnostic challenge. BMJ Case Rep 2022; 15:e244015. [PMID: 35217547 PMCID: PMC8883184 DOI: 10.1136/bcr-2021-244015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 37-year-old Caucasian woman with abdominal distension and loss of weight. She was initially presumed to be a case of ovarian malignancy due to an elevated serum cancer antigen 125 (CA 125) level and imaging of abdomen and pelvis that showed ascites and bulky ovaries. However, histological examination of biopsy later revealed it to be a case of abdominal tuberculosis (AbT). Ascitic fluid was also found to be positive for Mycobacterium tuberculosis by whole genome sequencing. The patient was started on antituberculosis treatment following which she showed a significant improvement in her symptoms.
Collapse
Affiliation(s)
- Ananya Das
- Medicine, West Cumberland Hospital, Whitehaven, Cumbria, UK
| | - Paul Mead
- Nephrology, West Cumberland Hospital, Whitehaven, Cumbria, UK
| | - Hilal Razvi Mala
- General Medicine, West Cumberland Hospital, Whitehaven, Cumbria, UK
| |
Collapse
|
29
|
Barbina S, Kavin U, Sutton MM, Heincelman M, Thomas MK. Ascitic Fluid Analysis Leading to the Diagnosis of Constrictive Pericarditis in 2 Patients. J Investig Med High Impact Case Rep 2022; 10:23247096221097530. [PMID: 35546528 PMCID: PMC9112309 DOI: 10.1177/23247096221097530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Although well documented, constrictive pericarditis is a rare entity and an uncommon cause of heart failure. A stiff and noncompliant pericardium creates the disease's unique hemodynamics and leads to elevated venous pressures, hepatic sinusoidal congestion, and draining of protein-rich fluid into the peritoneal cavity presenting as ascites. The low incidence in addition to its varied and subtle clinical presentations can often lead to a delay in diagnosis. Here, we present 2 clinical cases of constrictive pericarditis in which ascitic fluid analysis was important-one patient who presented with new-onset ascites with concern for cirrhosis and another patient who presented with symptoms concerning for heart failure with ascites. Through their hospital course and workup, we highlight the importance of diagnostic sampling of ascitic fluid to prompt the consideration of constrictive pericarditis followed by utilizing advanced diagnostics, such as echocardiogram and cardiac catheterization to reach the correct diagnosis in an otherwise often overlooked pathology.
Collapse
Affiliation(s)
- Sarah Barbina
- Department of Medicine, Medical
University of South Carolina, Charleston, USA
| | - Umakanthan Kavin
- Department of Medicine, Medical
University of South Carolina, Charleston, USA
| | - Michael M. Sutton
- Department of Medicine, Medical
University of South Carolina, Charleston, USA
| | - Marc Heincelman
- Department of Medicine, Medical
University of South Carolina, Charleston, USA
| | - Meghan K. Thomas
- Department of Medicine, Medical
University of South Carolina, Charleston, USA
| |
Collapse
|
30
|
Najafian N, Weber AT, Zuckerman JE, Zhang S, Saab S, Choi G. AL Lambda Amyloidosis Activates Acute Liver Failure in the Absence of Plasma Cell Dyscrasia. Dig Dis Sci 2022; 67:67-70. [PMID: 34655012 DOI: 10.1007/s10620-021-07253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/09/2022]
Abstract
A patient with systemic amyloidosis developed portal hypertension, acute liver failure and multiorgan dysfunction. Extensive testing was unrevealing for paraproteinemia, plasma cell dyscrasia, infectious, or inflammatory conditions. He was transferred to our institution for orthotopic liver transplant evaluation but was ultimately declined given clinical instability and dysautonomia. Post-mortem evaluation revealed extensive amyloid deposition in multiple organs determined to be AL-lambda amyloidosis.
Collapse
Affiliation(s)
- Nilofar Najafian
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Andrew T Weber
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jonathan E Zuckerman
- Departments of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sarah Zhang
- Departments of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sammy Saab
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
- Departments of Nursing, University of California at Los Angeles, Los Angeles, CA, USA.
- Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA.
| | - Gina Choi
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
31
|
Lichoska-Josifovikj F, Grivceva-Stardelova K, Joksimovikj N, Todorovska B, Trajkovska M, Lichoski L. PREDICTIVE POTENTIAL OF BLOOD AND ASCITIC FLUID LABORATORY PARAMETERS FOR SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH CIRRHOSIS. Georgian Med News 2021:69-75. [PMID: 35000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patients with spontaneous bacterial peritonitis (SBP) usually have serious complications associated with deteriorating synthetic and excretory function of the liver cells, and require hospitalization and regular monitoring of biochemical parameters in blood and ascites.Aims - to determine the average values of laboratory parameters in blood and ascites in patients with SBP, to determine whether there is a difference in the average values between patients with SBP and non-SBP as well as their predictive power for the diagnosis of SBP.The study was designed as a prospective-analytical-observational and was conducted at the University Clinic for Gastroenterohepatology in Skopje for a period of one year. The study population included hospitalized patients with established liver cirrhosis, regardless of etiology; 70 patients, divided into two groups, 35 patients with SBP and 35 non-SBP. The selection of patients who were included in the study was conducted according to pre-determined inclusion and exclusion criteria. All diagnostic test specimens were immediately referred to the Central Clinical Laboratory. Five ml of a total of 10 ml of ascites were used for automatic counting of PMNC, and 5 ml for biochemical analysis of ascites (total sweat-WP). At the same time, for the needs of biochemical blood tests, a venipuncture of 10 ml of blood was performed.The univariate analysis showed that INR, albumin/s, creatinine/s, TP/ascites (p=0.039, p=0.035, p=0.013, p=0.000, p=0.030) were independent risk factors for the development of SBP. INR>1.2 significantly increased the chance of SBP by three times (Exp (B) = 3.222 (CI (1.063-9.768)). Serum albumin<35 g/L significantly increased the chance of SBP by five and a half times (Exp (B) = 5.712 (CI (1.135-28.748). Creatinine/s>115 µmol/L significantly increased the chance of SBP by four times (Exp (B) = 4.070 (CI (1.352-12.255)).TP in ascites ≤10 significantly increased the chance of SBP by five times (Exp (B) = 5.337 (CI (6.243-416.469). The multivariate logistic analysis confirmed that INR>1.2 and creatinine>115 µmol/L were statistical risk factors (predictors) that increased the chance of SBP.Low serum albumin values are independent risk factors for predicting SBP and significantly increase the risk of developing SBP by five and a half times. Patients with SBP have lower mean TP values in ascites than non-SBP. Low TP values in ascites<11g/L are independent risk factors for the development of SBP and significantly increase the risk of SBP by five times. Of course, additional and larger studies are necessary in order to confirm our conclusion in the future.
Collapse
Affiliation(s)
- Fana Lichoska-Josifovikj
- 1University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje, R. North Macedonia
| | - Kalina Grivceva-Stardelova
- 1University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje, R. North Macedonia
| | - Nenad Joksimovikj
- 1University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje, R. North Macedonia
| | - Beti Todorovska
- 1University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje, R. North Macedonia
| | - Meri Trajkovska
- 1University Clinical Centre "Mother Teresa", Clinic of Gasteroenterohepatology, Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje, R. North Macedonia
| | - Leonid Lichoski
- 2Faculty of Medicine, "Ss. Cyril and Methodius" University in Skopje, R. North Macedonia
| |
Collapse
|
32
|
Stone NE, Raj A, Young KM, DeLuca AP, Chrit FE, Tucker BA, Alexeev A, McDonald J, Benigno BB, Sulchek T. Label-free microfluidic enrichment of cancer cells from non-cancer cells in ascites. Sci Rep 2021; 11:18032. [PMID: 34504124 PMCID: PMC8429413 DOI: 10.1038/s41598-021-96862-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
The isolation of a patient's metastatic cancer cells is the first, enabling step toward treatment of that patient using modern personalized medicine techniques. Whereas traditional standard-of-care approaches select treatments for cancer patients based on the histological classification of cancerous tissue at the time of diagnosis, personalized medicine techniques leverage molecular and functional analysis of a patient's own cancer cells to select treatments with the highest likelihood of being effective. Unfortunately, the pure populations of cancer cells required for these analyses can be difficult to acquire, given that metastatic cancer cells typically reside in fluid containing many different cell populations. Detection and analyses of cancer cells therefore require separation from these contaminating cells. Conventional cell sorting approaches such as Fluorescence Activated Cell Sorting or Magnetic Activated Cell Sorting rely on the presence of distinct surface markers on cells of interest which may not be known nor exist for cancer applications. In this work, we present a microfluidic platform capable of label-free enrichment of tumor cells from the ascites fluid of ovarian cancer patients. This approach sorts cells based on differences in biomechanical properties, and therefore does not require any labeling or other pre-sort interference with the cells. The method is also useful in the cases when specific surface markers do not exist for cells of interest. In model ovarian cancer cell lines, the method was used to separate invasive subtypes from less invasive subtypes with an enrichment of ~ sixfold. In ascites specimens from ovarian cancer patients, we found the enrichment protocol resulted in an improved purity of P53 mutant cells indicative of the presence of ovarian cancer cells. We believe that this technology could enable the application of personalized medicine based on analysis of liquid biopsy patient specimens, such as ascites from ovarian cancer patients, for quick evaluation of metastatic disease progression and determination of patient-specific treatment.
Collapse
Affiliation(s)
- Nicholas E Stone
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Abhishek Raj
- Department of Mechanical Engineering, Indian Institute of Technology Patna, Bihar, 801103, India
| | - Katherine M Young
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA, 30332-0535, USA
| | - Adam P DeLuca
- Department of Ophthalmology and Visual Science, Carver College of Medicine, Institute for Vision Research, University of Iowa, Iowa City, IA, 52242, USA
| | - Fatima Ezahra Chrit
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Budd A Tucker
- Department of Ophthalmology and Visual Science, Carver College of Medicine, Institute for Vision Research, University of Iowa, Iowa City, IA, 52242, USA
| | - Alexander Alexeev
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - John McDonald
- School of Biology, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA, 30332-0405, USA
| | | | - Todd Sulchek
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
| |
Collapse
|
33
|
Donepudi R, Shamshirsaz AA, Espinoza J, Sanz-Cortes M, Belfortv MA, Nassr AA. Peritoneal-amniotic shunt in management of urinary ascites complicating fetal lower urinary tract obstruction. Ultrasound Obstet Gynecol 2021; 58:320-322. [PMID: 32770819 DOI: 10.1002/uog.22170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- R Donepudi
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M Sanz-Cortes
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | | | - A A Nassr
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| |
Collapse
|
34
|
Kai K, Hashiguchi M, Kurihara M, Tanaka Y, Kitamura S, Nakamura M, Shichijo C, Yamamoto-Rikitake M, Okuma R, Hikari T, Okuma E, Uchiyama M, Aoki S, Nakao Y, Yokoyama M, Aishima S. Cytological Appearances of Ovarian Seromucinous Borderline Tumor in Ascites: Presentation of 2 Cases. Acta Cytol 2021; 65:440-447. [PMID: 34284376 DOI: 10.1159/000517313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Seromucinous borderline tumor (SMBT) is a rare neoplasm which was newly defined in the 2014 WHO classification. Although the clinical and histopathological characteristics of SMBT have been well described, its cytological characteristics have not. We recently experienced 2 cases of SMBT which were defined by cytological findings of ascites. CASE PRESENTATION Case 1 was a 65-year-old Japanese woman. Preoperative imaging studies revealed abundant ascites and a cystic tumor, with a solid component measuring 13 cm on the left ovary. Radical surgery was performed during the intraoperative diagnosis of ovarian borderline tumor, made by histological examinations of frozen tumor sections. The cytological smears of preoperatively and intraoperatively collected ascites showed many atypical cells resembling reactive mesothelial cells. Alcian-blue staining of cell block sections revealed intracytoplasmic mucin, and the results of immunohistochemistry were consistent with SMBT. The final pathological diagnosis of tumor was SMBT. Case 2 was a 28-year-old Japanese woman. Preoperative imaging studies revealed a small amount of ascites and cystic tumors with solid components in the bilateral ovaries. She initially underwent fertility preservation surgery. SMBT was suspected by cytological examination of smears of intraoperatively collected ascites and the findings of cell block. She underwent additional radical surgery based on a final pathological diagnosis of SMBT. CONCLUSION In our experience, the tumor cells of SMBT in ascites mimicked reactive mesothelial cells. The nuclear atypia of SMBTs was intermediate between that of reactive mesothelial cells and serous carcinoma. The immunohistochemistry and mucin staining using cell block were very helpful for facilitating the cytodiagnosis of SMBT.
Collapse
Affiliation(s)
- Keita Kai
- Department of Pathology, Saga University Hospital, Saga, Japan
| | - Mariko Hashiguchi
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Makiko Kurihara
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuya Tanaka
- Department of Pathology, Saga University Hospital, Saga, Japan
| | - Sho Kitamura
- Department of Pathology, Saga University Hospital, Saga, Japan
| | - Mitsuo Nakamura
- Department of Pathology, Saga University Hospital, Saga, Japan
| | - Chika Shichijo
- Department of Pathology & Microbiology, Saga University Faculty of Medicine, Saga, Japan
| | | | - Ryoichi Okuma
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Takako Hikari
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Emi Okuma
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Michiko Uchiyama
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Shigehisa Aoki
- Department of Pathology & Microbiology, Saga University Faculty of Medicine, Saga, Japan
| | - Yoshifumi Nakao
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics & Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinichi Aishima
- Department of Pathology, Saga University Hospital, Saga, Japan
- Department of Pathology & Microbiology, Saga University Faculty of Medicine, Saga, Japan
| |
Collapse
|
35
|
Araj FG, Balani JP, Amin AA, Mammen PPA, Garg S, Luna M. Ascites and Edema After Bicaval Orthotopic Heart Transplant. J Invasive Cardiol 2021; 33:E581-E583. [PMID: 34224390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
IVC stenosis is a rare complication of bicaval orthotopic heart transplant. IVC stenosis can occur at either the cavo-atrial anastomosis, or the caval cannulation site, with presentations ranging from acute shock early post transplant to a more indolent course. Causes include extensive hemostatic suturing, fibrous contraction, and donor-recipient size mismatch. Treatment strategies include percutaneous balloon angioplasty, stenting, and surgical revision. Evaluating for IVC stenosis is recommended for unexplained lower-extremity edema, new-onset ascites, or liver abnormalities after bicaval heart transplant.
Collapse
Affiliation(s)
- Faris G Araj
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Professional Office Bldg. 2, Suite 600, 5939 Harry Hines Blvd, Dallas, TX 75390-9252 USA.
| | | | | | | | | | | |
Collapse
|
36
|
Marques de Sá I, Bibi M, Moura M, Carvalhana S, Cortez-Pinto H. No evidence of benefit of routine ascitic fluid analysis in refractory ascites undergoing therapeutic paracentesis. Eur J Gastroenterol Hepatol 2021; 33:942. [PMID: 33908390 DOI: 10.1097/meg.0000000000002119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | - Mário Bibi
- Medicine, Unidade Local de Saúde de Matosinhos, Porto
| | - Miguel Moura
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Departamento de Gastrenterologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Sofia Carvalhana
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Departamento de Gastrenterologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Departamento de Gastrenterologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| |
Collapse
|
37
|
Abdel Hafez H, Madani H, Abdel Alem S, Farrag A, Fathy W, Abdo M. Is Serum-Ascites Vitamin D Gradient a Valid Marker for Diagnosing Spontaneous Bacterial Peritonitis in Patients with Cirrhotic Ascites? Lab Med 2021; 52:567-573. [PMID: 33939819 DOI: 10.1093/labmed/lmab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Spontaneous bacterial peritonitis (SBP) is considered the paradigmatic model of infection in patients with liver cirrhosis. Therefore, there is a need for an accurate and rapid method for SBP diagnosis. The aim of this study was to evaluate the validity of serum-ascites 25-hydroxyvitamin D (25-OH vitamin D) gradient (SADG) as a marker for diagnosing SBP in patients with cirrhotic ascites. METHODS We conducted a cross-sectional analytic study of 88 patients with portal hypertensive ascites resulting from liver cirrhosis of any etiology. The demographic, clinical, and laboratory characteristics of the patients were recorded. The level of 25-OH vitamin D in serum and ascitic fluid was measured using high-performance liquid chromatography autoanalyzer. The SADG was calculated with the formula: 25-OH vitamin D in serum - 25-OH vitamin D in ascites. RESULTS Vitamin D deficiency was detected in 89.8% of the studied patients. The SADG values ranged between 0 and 69.2 ng/mL, with a median value of 5.58 ng/mL. It was significantly lower in patients with SBP than in those without SBP (P = .004). The area under the curve for SADG in exclusion of SBP was 0.67 at a cutoff value of ≥5.57 ng/mL. CONCLUSION We found that SADG may be a valid marker of SBP in patients with cirrhotic ascites.
Collapse
Affiliation(s)
- Hanan Abdel Hafez
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan Madani
- Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shereen Abdel Alem
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Farrag
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael Fathy
- Tropical Medicine Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Mahmoud Abdo
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
38
|
Zhu LP, Khan S, Hui YY, Yang B, Wang SY, Sun KD, Yu ZH, Zhao JW, Wang BM, Chen X. IgG4-Related Disease with Ascites: Report of a Case Simulating Primary Peritoneal Papillary Serous Carcinoma. Dig Dis Sci 2021; 66:1751-1756. [PMID: 32556817 DOI: 10.1007/s10620-020-06376-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/30/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Lan-Ping Zhu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Samiullah Khan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Yang-Yang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Bo Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Sai-Yu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Kai-di Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Zi-Han Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Jing-Wen Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Bang-Mao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China.
| |
Collapse
|
39
|
Karnsakul W, Wasuwanich P, Ingviya T, Laengvejkal P, Vasilescu A, Imteyaz H, Scheimann AO. Clinical usage of serum albumin to ascitic fluid albumin gradient and ascitic fluid total protein in pediatric ascites. Clin Res Hepatol Gastroenterol 2021; 45:101549. [PMID: 33268292 DOI: 10.1016/j.clinre.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal paracentesis is performed as a diagnostic test in children with ascites. Serum albumin to ascitic fluid albumin gradient (SAAG) is frequently used in adults to distinguish types of portal hypertension. We aim to investigate the utilization of SAAG and other biomarkers in determining the etiology of significant ascites in children. METHODS In this retrospective study, children aged 0-21 years with significant ascites were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and medical records during the period 1983-2010. Medical records of children who had abdominal paracentesis were examined in detail. RESULTS 207 children had significant ascites and of those children, 20 (9.6%) had abdominal paracentesis. Our data showed that high albumin gradient (SAAG ≥ 1.1 g/dL) differentiates causes of ascites secondary to portal hypertension (cirrhosis, hepatic vein outflow obstruction, or congestive hepatopathy) from other causes. In addition, ascitic fluid total protein (AFTP) may help in differential diagnosis of ascites. Children with high SAAG manifest clinical features of portal hypertension including esophageal varices or variceal hemorrhage. CONCLUSION Among patients with initially unclear causes of ascites, SAAG and AFTP can provide guidance for appropriate investigations.
Collapse
Affiliation(s)
- Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Paul Wasuwanich
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Thammasin Ingviya
- Medical Data Center for Research and Innovation, Prince of Songkla University, Songkhla, Thailand; Department of Family and Preventive Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pavis Laengvejkal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra Vasilescu
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hejab Imteyaz
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann O Scheimann
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
40
|
Faisal MS, Singh T, Amin H, Esfeh JM. A guide to diagnosing and managing ascites in cirrhosis. J Fam Pract 2021; 70:174-181. [PMID: 34339360 DOI: 10.12788/jfp.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Combined serum and ascites fluid measurements point to the cause of ascites. For patients with modest edema, a reduced weight-loss target with diuresis may be acceptable.
Collapse
Affiliation(s)
- Muhammad Salman Faisal
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
| | - Tavankit Singh
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
| | - Hina Amin
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
| | - Jamak Modaresi Esfeh
- Department of Internal Medicine (Dr. Faisal) and Department of Gastroenterology, Hepatology and Nutrition (Drs. Singh, Amin, and Modaresi Esfeh), Cleveland Clinic, Ohio
| |
Collapse
|
41
|
Abstract
The differential diagnosis of benign ascites and malignant ascites is incredibly challenging for clinicians. This research aimed to develop a user-friendly predictive model to discriminate malignant ascites from non-malignant ascites through easy-to-obtain clinical parameters. All patients with new-onset ascites fluid were recruited from January 2014 to December 2018. The medical records of 317 patients with ascites for various reasons in Renmin Hospital of Wuhan University were collected and reviewed retrospectively. Thirty-six parameters were included and selected using univariate logistic regression, multivariate logistic regression, and receiver operating characteristic (ROC) curve analyses to establish a mathematical model for differential diagnosis, and its diagnostic performance was validated in the other groups. Age, cholesterol, hypersensitivity C-reactive protein (hs-CRP) in serum, ascitic fluid adenosine deaminase (AF ADA), ascitic fluid lactate dehydrogenase (AF LDH) involvement in a 5-marker model. With a cut-off level of 0.83, the sensitivity, specificity, accuracy, and area under the ROC of the model for identifying malignant ascites in the development dataset were 84.7%, 88.8%, 87.6%, and 0.874 (95% confidence interval [CI], 0.822-0.926), respectively, and 80.9%, 82.6%, 81.5%, and 0.863 (95% CI,0.817-0.913) in the validation dataset, respectively. The diagnostic model has a similar high diagnostic performance in both the development and validation datasets. The mathematical diagnostic model based on the five markers is a user-friendly method to differentiate malignant ascites from benign ascites with high efficiency.
Collapse
Affiliation(s)
- Ying-Yun Guo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Xiu-Lan Peng
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei, 430050, China
| | - Na Zhan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Shan Tian
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Jiao Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | | |
Collapse
|
42
|
Aithal GP, Palaniyappan N, China L, Härmälä S, Macken L, Ryan JM, Wilkes EA, Moore K, Leithead JA, Hayes PC, O'Brien AJ, Verma S. Guidelines on the management of ascites in cirrhosis. Gut 2021; 70:9-29. [PMID: 33067334 PMCID: PMC7788190 DOI: 10.1136/gutjnl-2020-321790] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
Abstract
The British Society of Gastroenterology in collaboration with British Association for the Study of the Liver has prepared this document. The aim of this guideline is to review and summarise the evidence that guides clinical diagnosis and management of ascites in patients with cirrhosis. Substantial advances have been made in this area since the publication of the last guideline in 2007. These guidelines are based on a comprehensive literature search and comprise systematic reviews in the key areas, including the diagnostic tests, diuretic use, therapeutic paracentesis, use of albumin, transjugular intrahepatic portosystemic stent shunt, spontaneous bacterial peritonitis and beta-blockers in patients with ascites. Where recent systematic reviews and meta-analysis are available, these have been updated with additional studies. In addition, the results of prospective and retrospective studies, evidence obtained from expert committee reports and, in some instances, reports from case series have been included. Where possible, judgement has been made on the quality of information used to generate the guidelines and the specific recommendations have been made according to the 'Grading of Recommendations Assessment, Development and Evaluation (GRADE)' system. These guidelines are intended to inform practising clinicians, and it is expected that these guidelines will be revised in 3 years' time.
Collapse
Affiliation(s)
- Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Naaventhan Palaniyappan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Louise China
- Institute of Liver Disease and Digestive Health, University College London, London, UK
| | - Suvi Härmälä
- Institute of Health Informatics, University College London, London, UK
| | - Lucia Macken
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Jennifer M Ryan
- Institute of Liver Disease and Digestive Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Emilie A Wilkes
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kevin Moore
- Institute of Liver Disease and Digestive Health, University College London, London, UK
| | - Joanna A Leithead
- Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter C Hayes
- Hepatology Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alastair J O'Brien
- Institute of Liver Disease and Digestive Health, University College London, London, UK
| | - Sumita Verma
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| |
Collapse
|
43
|
Arasan SN, Yenigun EC, Cevher SK, Dede F. Amlodipine Induced Massive Ascites, a Rare Clinical Case. Iran J Kidney Dis 2020; 14:517-519. [PMID: 33277458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/22/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Calcium channel blockers (CCBs) are commonly used agents in the treatment of hypertension as part of monotherapy or combination therapy. Peripheral edema is the most common side effect that requires discontinuation or replacement of treatment. Some studies in the literature have shown that long-acting dihydropyridine type CCBs lead chylous ascites in peritoneal dialysis patients. However, amlodipine-associated serous ascites cases are not available in the literature. CASE REPORT In this case report, we describe a rare case of amlodipine induced massive ascites in a 30-year-old male with renal transplantation. CONCLUSION We aimed to create awareness that pharmacologic causes should be considered in cases of ascites of unknown aetiology.
Collapse
Affiliation(s)
- Sema Nur Arasan
- University of Health Science, Ankara City Hospital, Department of Internal Medicine, Ankara, Turkey.
| | | | | | | |
Collapse
|
44
|
Cervantes CE, Menez S, Hanouneh M. Apparent AKI in a Patient with Ascites Following Laparoscopic Hysterectomy. Kidney360 2020; 1:1330-1331. [PMID: 35372869 PMCID: PMC8815501 DOI: 10.34067/kid.0002852020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Carmen Elena Cervantes
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Menez
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad Hanouneh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
45
|
Petrenko AP, Castelo-Branco C, Marshalov DV, Kuligin AV, Shifman EM, Nesnova ES. Assessing the Usefulness of Severity Markers in Women with Ovarian Hyperstimulation Syndrome. Reprod Sci 2020; 28:1041-1048. [PMID: 33063288 DOI: 10.1007/s43032-020-00339-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
The present study aims to assess the usefulness of severity markers in women with ovarian hyperstimulation syndrome (OHSS). An observational study was designed including 76 women with varying degrees of severity of OHSS. Clinical history, physical examination, laboratory tests, and ultrasound measurement of the ovarian size and ascites index were carried out in all patients. Intra-abdominal pressure (IAP) was measured using an intravesical Foley Manometer catheter. Ascites index and ovarian volume increased progressively being highest in the most severe stage of OHSS. The median IAP in mild OHSS was found to be lower than that in the moderate and severe OHSS (4.0 mm, 12 mm, and 16.0 mm, respectively). Critical cases of OHSS presented the highest IAP (25.0 mm). IAP did not reach the level of intra-abdominal hypertension in mild OHSS, whereas moderate and severe OHSS was associated with intra-abdominal hypertension grade I and grade II-III, respectively. Values of IAP in critical OHSS were found similar to those observed in abdominal compartment syndrome patients. The IAP showed a strong positive correlation with ovarian volume and ascites index. The reduction of IAP after paracentesis was greater among critical OHSS patients. The ovarian volume and the level of intra-abdominal hypertension are related to the severity of OHSS and are of particular importance in the initialization of the syndrome. Ascites index is simple and convenient and can serve as an indirect marker of the abdominal reserve volume. In conjunction with clinical and laboratory data, ascites index and IAP values might be indicators for paracentesis.
Collapse
Affiliation(s)
- Aleksei Petrovich Petrenko
- Clinic Institute of Gynecology, Obstetrics and Neonatology-Hospital Clinic Barcelona, Faculty of Medicine-University of Barcelona, Institut d ´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
- City Clinical Hospital №1 named after Yu.Ya. Gordeev, Saratov, Russian Federation
| | - Camil Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology-Hospital Clinic Barcelona, Faculty of Medicine-University of Barcelona, Institut d ´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Dimitry Vasilevich Marshalov
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
- City Clinical Hospital №1 named after Yu.Ya. Gordeev, Saratov, Russian Federation
| | - Alexander Valerievich Kuligin
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
| | - Efim Munevich Shifman
- Department of Anesthesiology and Critical Care, State Budgetary Healthcare Institution of Moscow Region M.F. Vladimirsky Moscow's Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Sergeevna Nesnova
- City Clinical Hospital №1 named after Yu.Ya. Gordeev, Saratov, Russian Federation
- Department of Hospital Surgery, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
| |
Collapse
|
46
|
Montacer KE, Hliwa W, Rhaoussi FE, Tahiri M, Haddad F, Bellabah A, Badre W. [Autoimmune hepatitis following acute severe Epstein-Barr virus hepatitis]. Pan Afr Med J 2020; 37:77. [PMID: 33244340 PMCID: PMC7680232 DOI: 10.11604/pamj.2020.37.77.20817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/21/2019] [Indexed: 12/02/2022] Open
Abstract
Non-alphabetical hepatitis (Epstein Barr virus -EBV-, cytomegalovirus -CMV-, Herpes simplex virus -HSV-, varicella zoster virus -VZV-etc.) may be a mode of revelation of several underlying chronic liver diseases including autoimmune hepatitis (HAI). We report a peculiar case of acute EBV hepatitis, revealing type I autoimmune hepatitis confirmed by liver biopsy through puncture in a female patient on breast cancer treatment. The study involved a 29-year-old female patient on breast cancer treatment scheduled to receive radiotherapy and chemotherapy, hospitalized for acute severe hepatitis (fever with jaundice, hypertransaminasemia (normal AST level 47 and normal ALT level 23 and prothrombin activity 25%). The test for viral hepatitis A, B, C, and E was negative and subhepatic veins were free on doppler. Non-alphabetical hepatitis was suspected based on fever with jaundice. Patient's assessment showed recent EBV infection diagnosed on the basis of the presence of anti-VAC IgM/G and anti-EBNA Ab IgG. The patient received acyclovir for 10 days. Progression was marked by ascites. The diagnosis of autoimmune hepatitis was retained based on laboratory tests (gamma peak on serum protein electrophoresis and positive anti-nuclear antibodies) and histological examination. Clinical-biological remission was obtained with corticosteroid therapy. EBV infections should be investigated in immunocompromised patients with fever in the clinical course of acute hepatitis. Practitioners should also suspect it in patients with persistent cytolysis following an infectious episode in order to prevent the occurrence of autoimmune hepatitis, in particular in female patients, in a context of self-immunity and negative serological tests for alphabetical viral hepatitis.
Collapse
Affiliation(s)
- Khaoula El Montacer
- Service d'Hépato-Gastro-Entérologie du Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Wafaa Hliwa
- Service d'Hépato-Gastro-Entérologie du Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Fz El Rhaoussi
- Service d'Hépato-Gastro-Entérologie du Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Mohammed Tahiri
- Service d'Hépato-Gastro-Entérologie du Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Fouad Haddad
- Service d'Hépato-Gastro-Entérologie du Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Ahmed Bellabah
- Service d'Hépato-Gastro-Entérologie du Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Wafaa Badre
- Service d'Hépato-Gastro-Entérologie du Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| |
Collapse
|
47
|
Tu B, Zhang YN, Bi JF, Xu Z, Zhao P, Shi L, Zhang X, Yang G, Qin EQ. Multivariate predictive model for asymptomatic spontaneous bacterial peritonitis in patients with liver cirrhosis. World J Gastroenterol 2020; 26:4316-4326. [PMID: 32848336 PMCID: PMC7422546 DOI: 10.3748/wjg.v26.i29.4316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/02/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous bacterial peritonitis (SBP) is a detrimental infection of the ascitic fluid in liver cirrhosis patients, with high mortality and morbidity. Early diagnosis and timely antibiotic administration have successfully decreased the mortality rate to 20%-25%. However, many patients cannot be diagnosed in the early stages due to the absence of classical SBP symptoms. Early diagnosis of asymptomatic SBP remains a great challenge in the clinic.
AIM To establish a multivariate predictive model for early diagnosis of asymptomatic SBP using positive microbial cultures from liver cirrhosis patients with ascites.
METHODS A total of 98 asymptomatic SBP patients and 98 ascites liver cirrhosis patients with negative microbial cultures were included in the case and control groups, respectively. Multiple linear stepwise regression analysis was performed to identify potential indicators for asymptomatic SBP diagnosis. The diagnostic performance of the model was estimated using the receiver operating characteristic curve.
RESULTS Patients in the case group were more likely to have advanced disease stages, cirrhosis related-complications, worsened hematology and ascites, and higher mortality. Based on multivariate analysis, the predictive model was as follows: y (P) = 0.018 + 0.312 × MELD (model of end-stage liver disease) + 0.263 × PMN (ascites polymorphonuclear) + 0.184 × N (blood neutrophil percentage) + 0.233 × HCC (hepatocellular carcinoma) + 0.189 × renal dysfunction. The area under the curve value of the established model was 0.872, revealing its high diagnostic potential. The diagnostic sensitivity was 73.5% (72/98), the specificity was 86.7% (85/98), and the diagnostic efficacy was 80.1%.
CONCLUSION Our predictive model is based on the MELD score, polymorphonuclear cells, blood N, hepatocellular carcinoma, and renal dysfunction. This model may improve the early diagnosis of asymptomatic SBP.
Collapse
Affiliation(s)
- Bo Tu
- Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Yue-Ning Zhang
- Center of Hepatology and Gastroenterology, Beijing Capital Medical University You’an Hospital, Beijing 100039, China
| | - Jing-Feng Bi
- Department of Clinical and Translational Medicine, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Zhe Xu
- Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Peng Zhao
- Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Lei Shi
- Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Xin Zhang
- Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Guang Yang
- Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - En-Qiang Qin
- Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| |
Collapse
|
48
|
Gonda M, Osuga T, Ikura Y, Hasegawa K, Kawasaki K, Nakashima T. Optimal treatment strategies for hepatic portal venous gas: A retrospective assessment. World J Gastroenterol 2020; 26:1628-1637. [PMID: 32327911 PMCID: PMC7167419 DOI: 10.3748/wjg.v26.i14.1628] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) generally indicates poor prognoses in patients with serious intestinal damage. Although surgical removal of the damaged portion is effective, some patients can recover with conservative treatments.
AIM To establish an optimal treatment strategy for HPVG, we attempted to generate computed tomography (CT)-based criteria for determining surgical indication, and explored reliable prognostic factors in non-surgical cases.
METHODS Thirty-four cases of HPVG (patients aged 34-99 years) were included. Necessity for surgery had been determined mainly by CT findings (i.e. free-air, embolism, lack of contrast enhancement of the intestinal wall, and intestinal pneumatosis). The clinical data, including treatment outcomes, were analyzed separately for the surgical cases and non-surgical cases.
RESULTS Laparotomy was performed in eight cases (surgical cases). Seven patients (87.5%) survived but one (12.5%) died. In each case, severe intestinal damage was confirmed during surgery, and the necrotic portion, if present, was removed. Non-occlusive mesenteric ischemia was the most common cause (n = 4). Twenty-six cases were treated conservatively (non-surgical cases). Surgical treatments had been required for twelve but were abandoned because of the patients’ poor general conditions. Surprisingly, however, three (25%) of the twelve inoperable patients survived. The remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments, and only one patient (7%) died. Comparative analyses of the fatal (n = 10) and recovery (n = 16) cases revealed that ascites, peritoneal irritation signs, and shock were significantly more frequent in the fatal cases. The mortality was 90% if two or all of these three clinical findings were detected.
CONCLUSION HPVG related to intestinal necrosis requires surgery, and our CT-based criteria are probably useful to determine the surgical indication. In non-surgical cases, ascites, peritoneal irritation signs and shock were closely associated with poor prognoses, and are applicable as predictors of patients’ prognoses.
Collapse
Affiliation(s)
- Masanori Gonda
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Tatsuya Osuga
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Yoshihiro Ikura
- Department of Pathology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Kazunori Hasegawa
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Kentaro Kawasaki
- Department of Surgery, Takatsuki General Hospital, Takatsuki 5691192, Japan
| | - Takatoshi Nakashima
- Department of Gastroenterology, Takatsuki General Hospital, Takatsuki 5691192, Japan
| |
Collapse
|
49
|
Liang M, Liwen Z, Bingfang C, Yanbo D, Jianping C. Eosinophilic gastroenteritis with multiple serous membrane effusion as the first sign: a case report and literature review. J Int Med Res 2020; 48:300060520917274. [PMID: 32321384 PMCID: PMC7180310 DOI: 10.1177/0300060520917274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
Multiple serous membrane effusion (MSSE) as the first sign of eosinophilic gastroenteritis is extremely rare, and its clinical features and treatment methods have not been well described. The clinical characteristics, diagnosis, and treatment methods of MSSE in a 44-year-old woman were retrospectively reviewed. Laboratory testing revealed an elevated eosinophil count and serum immunoglobulin E level. The levels of all tumor markers were normal, but the CA125 level in serum and ascitic fluid was significantly increased. Ultrasonography showed a large amount of ascites and a moderate amount of pleural effusion. Echocardiography showed a small amount of pericardial effusion. Chest and abdominal computed tomography showed gastrointestinal wall thickening. Moreover, eosinophilic infiltration was detected in duodenal and rectal biopsy samples that had been collected during endoscopic examination of the upper gastrointestinal system. The patient was treated with 30 mg of prednisolone, and seafood was excluded from her diet for 4 weeks. The prednisolone was tapered over 8 weeks and continued at 5 mg prednisolone daily thereafter. The MSSE and peripheral eosinophilia showed a dramatic response to the steroid treatment. This case indicates that we should be highly aware of MSSE as the first clinical manifestation of eosinophilic gastroenteritis.
Collapse
Affiliation(s)
- Ma Liang
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
| | - Zhang Liwen
- Department of Pediatrics, The Second People’s Hospital of
Changzhou, Affiliate Hospital of NanJing Medical University, Changzhou, Jiangsu,
China
| | - Chen Bingfang
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
| | - Ding Yanbo
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
| | - Chen Jianping
- Department of Digestive Disease, The First People’s Hospital of
Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou,
Jiangsu, China
| |
Collapse
|
50
|
Kaplan M, Ateş İ, Akdoğan Kayhan M, Kaçar S, Gökbulut V, Coşkun O, Erel Ö, Alışık M, Güçlü K. Diagnostic utility of oxidative and non-oxidative markers for spontaneous bacterial peritonitis in non-malign ascites. Acta Gastroenterol Belg 2020; 83:279-284. [PMID: 32603047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In this study, we aimed to investigate the diagnostic availability of oxidant and antioxidant parameters in ascites for spontaneous bacterial peritonitis (SBP). MATERIAL AND METHODS This study was carried out between July and October 2018 with 25 patients with SBP and 24 patients without SBP. Patients with acute infection, those taking vitamin supplements and antioxidant medication, smoking and drinking alcohol, and patients without ascites culture were excluded from the study. RESULTS In patients with SBP compared those without SBP median paraoxonase (3.1 vs 15.6 ; p <0.001), median stimulated paraoxonase (12.6 vs 53.1 ; p <0.001), median arylesterase (769,9 vs 857,5 ; p = 0,003) and median catalase (10 vs 22,2 ; p = 0,003) were found to be lower and median myeloperoxidase (8.1 vs 1.1 ; p <0.001) were found to be higher. There was a positive correlation between paraoxonase levels and stimulated paraoxonase levels, arylesterase levels and catalase levels, there was a negative correlation between paraoxonase levels and myeloperoxidase levels. Paraoxonase levels 3.7 and lower, stimulated paraoxonase levels 25.8 and lower, arylesterase levels 853.4 and lower, catalase levels 11.8 and lower and myeloperoxidase levels 2.7 and more predicted the the presence of SBP with high specificity and high sensitivity. Paraoxonase and stimulated paraoxo-nase levels were found to have superior performance in predicting the presence of SBP compared to arylesterase levels (p <0.05). CONCLUSION In this study it was shown that paraoxonase, stimulated paraoxonase, arylesterase, catalase and myeloperoxidase activities can be used for the diagnosis and severity of SBP.
Collapse
Affiliation(s)
- M Kaplan
- Ahi Evran University, Department of Gastroenterology, Kirsehir, Turkey
| | - İ Ateş
- Ankara Numune Training and Research Hospital, Department of Internal Medicine, Ankara, Turkey
| | - M Akdoğan Kayhan
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - S Kaçar
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - V Gökbulut
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - O Coşkun
- Turkey Yuksek Ihtisas Training and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Ö Erel
- Ankara Yildirim Beyazit University, Department of Biochemistry, Ankara, Turkey
| | - M Alışık
- Ankara Yildirim Beyazit University, Department of Biochemistry, Ankara, Turkey
| | - K Güçlü
- Ahi Evran University, Department of Biochemistry, Kirsehir, Turkey
| |
Collapse
|