new_n_lost
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A 56-year-old man with Polycythemia Vera is admitted with acute abdominal pain, nausea, vomiting and abdominal distension. He is apyrexial with tender hepatomegaly and Ascites; an ascitic tap reveals a high protein content and no organisms. What is the most likely diagnosis?
A. Spontaneous bacterial peritonitis
B. Budd��"Chiari syndrome
C. Veno-occlusive disease
D. Malignant liver disease
E. Haemochromatosis
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| mms
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D?
Polycythemia Vera is often a cause of Budd-Chiari syndrome but the ascitis has a high SAAG (Serum-Ascite Albumin Gradient)= is low in protein.
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| keepgoing
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b?
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| usmle4me
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?B
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| anji
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ans with explanation plzzzzzzzzzzz
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| new_n_lost
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MMS u had right all the way but made a slight mistake in SAAG levels high counts of Proteins r found in the Ascitic Fluid of Hepato-portal Congestion.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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Budd��"Chiari syndrome occurs following obstruction to the venous outflow of the liver due to occlusion of the hepatic vein. In one-third of the patients the cause is unknown. Patients with hypercoagulable states, such as Polycythemia Vera or leukemia, and women on the contraceptive pill are at risk. The acute form presents with abdominal pain, nausea, vomiting, tender hepatomegaly and ascites. Liver histology shows centrilobular congestion with hepatocyte atrophy. The chronic form presents with hepatomegaly, mild jaundice, ascites and splenomegaly with portal hypertension.
SAAG: The SAAG is the best single test for classifying ascites into portal hypertensive (SAAG >1.1 g/dL) and non��"portal hypertensive (SAAG <1.1 g/dL) causes. Calculated by subtracting the ascitic fluid albumin value from the serum albumin value, it correlates directly with portal pressure. The specimens should be obtained relatively simultaneously. The accuracy of the SAAG results is approximately 97% in classifying ascites. The terms high-albumin gradient and low-albumin gradient should replace the terms transudative and exudative in the description of Ascites.
Total protein: In the past, ascitic fluid has been classified as an exudate if the protein level is greater than or equal to 2.5 g/dL. However, the accuracy is only approximately 56% for detecting exudative causes. The total protein level may provide additional clues when used with the SAAG. An elevated SAAG and a high protein level are observed in most cases of ascites due to hepatic congestion. Those patients with malignant ascites have a low SAAG and a high protein level
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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- Patients usually have high protein concentrations (>2 g/dL). This may not be present in persons with the acute form of Budd-Chiari syndrome.
- The WBC count is usually less than 500/mL.
- The serum ascites–albumin gradient is usually less than 1.1 (except in the acute forms of the disease).
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| mms
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Thanks new-n-lost for the great questions and explanations that you are posting all the time!!!!
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| keepgoing
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thanks i dint know SAAG but now i know IT...!
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