Refractory ascites is defined as ascites that does not recede or that recurs shortly after therapeutic paracentesis, despite sodium restriction and diuretic treatment.
The gastric ulcer are staged, by using of the endoscopic staging system of Sakita, into 3 stages (active, healing, scarring) as follows.
A. Clinical context and clinical manifestations
1. History of biliary disease
2. Fever and/or chills
4. Abdominal pain (right upper quadrant or upper abdominal)
Removal of abdominal fluid is of value in evaluating patients with ascites of new onset or unknown etiology, and provides symptomatic relief in patients with known disease or in the setting of a decompensating clinical state. Abdominal paracentesis is a simple procedure that may be performed rapidly and with a minimum of equipment.
Diagnostic criteria for ZES include the following:
- Elevated levels of Basal Acid Output (BAO), greater than 15 mEq in unoperated patients and greater than 5 mEq if previous acid-reducing surgery has been performed;
- Elevated level of fasting serum gastrin (>100 pg/mL until 1994, >200 pg/mL since 1994);
- Abnormal results from stimulation testing with secretin (an increase of >200 pg/mL postinjection) or with calcium (an increase >395 pg/mL);
- Positive histologic confirmation of gastrinoma; or
- A combination of these criteria. Continue reading
Diagnostic Criteria for Wilson’s disease
- Low serum ceruloplasmin levels < 20 mg/dL (Normal range 20-50 mg/dL).
- Kayser – Fleischer rings in eyes.
- High liver copper levels > 250 micrograms/g dry weight (Normal range <35 micrograms/g dry weight).
- High 24 hr urinary copper levels > 100 micrograms /d or > 1.6 mmol/d (Normal range <50 micrograms/d or < 0.8 mmol/d).
- Radioisotope copper studies using 64Cu, 67Cu or 65Cu, which assesses ability to incorporate copper into ceruloplasmin. Continue reading
The diagnosis of a Functional Disorder of the Anus and Rectum always presumes the absence of a structural or biochemical explanation for the symptoms.
Indications for diagnostic paracentesis.
Cirrhotic patients with ascites at admission
Cirrhotic patients with ascites and signs or symptoms of infection: fever, leukocytosis, abdominal pain
Cirrhotic patients with ascites who present with a clinical condition that is deteriorating during hospitalization: renal function impairment, hepatic encephalopathy, gastrointestinal bleeding
Patients with new-onset ascites
Ranson Criteria to Predict Severity of Acute Pancreatitis
1. When three or more of the following are present on admission, a severe course complicated by pancreatic necrosis can be predicted with a sensitivity of 60-80%: