International surgical boards

2021-12-12 22:26:13 Open / Comment

2021-12-12 14:53:23 Serum ascites albumin gradient

This is used to differentiate between transudative ascites and exudative ascites.

In transudative ascites more fluid is passing from capillaries to the peritoneal space, and thus diluting whatever albumin is present inside the peritoneal space, for this reason if you subtract serum albumin level from ascitic fluid albumin level the gap between them will be greater.

In case of exudate, the underlying mechanism is mainly increased capillary permeability with leakage of albumin into the peritoneal space, so albumin concentration in ascitic fluid will go up, therefore when you subtract serum albumin from ascitic fluid albumin value, the number will be smaller.

For the reasons mentioned above, a serum ascites albumin gradient of greater than 1.1g/dL implies transudate, and a value of less than 1.1g/dL implies exudate.

N.B serum ascites albumin gradient was formulated because the traditional method of differenting between transudate and exudate is not accurate, it was customary to say that a protein content of more than 25 g implies exudate but in up to 30% of patients that is not the case. Open / Comment

2021-12-12 14:44:16 Open / Comment

2021-12-12 14:39:08 Open / Comment

2021-12-12 10:35:56 Open / Comment

2021-12-12 10:30:41 Open / Comment

2021-12-11 09:49:46 Open / Comment

2021-12-11 08:29:11 Intestinal lymphangiectasia

It is defined as abnormal dilatation of intestinal lymphatic vessels.

This can result from congenital malunion of lymphatic vessels, but it may occur due to physical obstruction of lymphatics such as in lymphoma, in filariasis, radiation injury or Whipple's disease.

Whipple's disease is an infection with Trophyrema whipplei (Gram - ve) it causes dense mucosal infiltration with macrophages that eventually occlude small lymphatic vessels.

Another cause is constrictive pericarditis where the very high central venous pressure impedes lymph drainage from thoracic duct.

Regardless of cause, lymph will ooze in bowel lumen with loss of fat (steatorrhea), proteins (edema) and lymphocytes (lymphopenia and hypogammaglobulinemia).

Endoscopy shows dilated lymphatic vessels known as lacteals (see figure), and biopsy reveals distended lymphatic vessels and may reveal the underlying cause. Open / Comment

2021-12-10 07:20:47 Clinical note

Significant loss of weight is defined as loss of more than 3kg in 6 month duration, and it imply an underlying disease. Open / Comment

2021-12-10 02:10:40 Open / Comment