AM Report 11/28/2016: Gastric Adenocarcinoma

Peritoneal Fluid Analysis:

  • Increased accumulation:
    • Increased capillary permeability
    • Increased venous pressure
    • Decreased protein (oncotic pressure)
  • Decreased clearance:
    • Increased lymphatic obstruction

Causes of ascities:

Transudative (<30 g/L ~ systemic disease)

  • Liver (cirrhosis)
  • Cardiac (RHF, constrictive pericarditis, etc.)
  • Renal failure
  • Hypoalbuminemia (nephrotic syndrome)

Exudative (>30 g/L ~ local disease)

  • Malignancy
  • Venous obstruction (Budd-Chiari)
  • Pancreatitis
  • Lymph obstruction
  • Infection (especially TB)

SBP:

  1. PMNs > 250 cells/mm3
  2. + bacterial culture
  3. Absence of secondary causes (i.e. bowel perforation, abscess, etc.)

SAAG:

  • >1.1 g/dL ~ portal hypertension (97% accurate) => Transudative effusion
  • <1.1 g/dL ~ absence of portal hypertension => Exudative effusion

Lymphocytic Ascities:

  • Peritoneal carcinomatosis (>50% lymphocytes)
  • Peritoneal TB (>70% lymphocytes)

Sister Mary Joseph’s Sign: hard periumbilica nodule ~ indicative of metastatic disease to abdomen – usually pelvic/GI primary.

picture5

Virchow’s Node: enlarged lymph node in the left supraclavicular fossa ~ indicates cancer in the abdomen.

picture6

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