20. Differential diagnosis of abdominal fluid accumulation Flashcards

1
Q

Pathophysiology of fluid accumulation?

A

Pathophysiology of fluid accumulation

Physiologically, there is continuous filtration from the arteriolar

capillaries which are then absorbed by the venous & lymphatic

circulation.

Fluid accumulation is caused by a defect to this mechanism, such as:

§ ↑ Hydrostatic pressure of the capillaries

§ ↑ Hydrostatic pressure of the interstitium

§ ↑ Capillary permeability

§ ↓ Oncotic pressure (hypoalbuminaemia)

§ Problems with the lymphatic circulation

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2
Q

Difference between transudate and exudate?

A

Types of fluid accumulation

TRANSUDATE AND EXUDATE

Transudate (stagnation)

§ Low protein content (clear appearance)

§ Fluid is pushed through capillaries due to high pressure

Exudate (inflammation)

§ High protein content (opaque)

§ Fluid leaks around capillary cells caused by inflammation

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3
Q

Difference between tansudate and exudate( SG, protein, WBC, RBC)

A
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4
Q

Potential causes of the different fluid types?

A
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5
Q

Differentiate between causes of transudate?

A

Differentiate between causes of transudate

PLE; PLN; Liver cirrhosis; Portal hypertension

§ Proteinuria: Exclusion by UPC measurement

§ Portal hypertension: US

Protein-losing enteropathy is suspected if all these apply:

§ ✗ Proteinuria

§ ✗ Portal hypertension

✓ Hypoalbuminaemia

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6
Q

Differentiate between uroperitoneum, tumours & exudate?

A

Differentiate between uroperitoneum, tumours & exudate

Uroperitoneum

Localisation of leakage is not always possible

Cause: Urinary bladder rupture

Always measure creatinine from abdominal fluids

Tumour

Not always visible on X-ray/US

Mixing of neoplastic/reactive mesothelial cells

If all other causes are excluded: Laparotomy

Exudate

Cause of inflammation is not always visible on X-ray/US

Cause: Corrugated intestines; Peritonitis; Pancreatitis

In case of septic exudate: Laparotomy

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7
Q

Chyloperitoneum ?

A

CHYLOPERITONEUM

Mesenteric lymph vessel = Cisterna chyli

DDx: Tumour; Lymphangiectasia

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8
Q

Haemorrhagic fluid?

A

HAEMORRHAGIC FLUID

DDx: Tumour; Trauma; Coagulopathy; Uroperitoneum; Intestinal

strangulation

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9
Q

Ascites?

A

Ascites

Abdominal fluid accumulation

Cats: Ascites + Ø pleural effusion → Ø Likelihood of cardiac origin

Dog: Could be of cardiac origin

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10
Q

Causes of different fluid types?

A

CAUSES OF DIFFERING FLUID TYPES

§ Heart failure: Mod. transudate (RSHF); Rarely chylous

§ Tumour: Mod. Transudate; Haemorrhagic fluid; Exudate

§ Infection: Exudate

§ Thrombosis: Mod. Transudate

§ Hypoproteinaemia: Transudate

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11
Q

Diagnosis?

A

DIAGNOSIS

Physical exam

Lab. D

§ Rivalta test: Differentiate between transudate & exudate

§ Modified transudate → Not pure transudate

Undulation test

Ultrasound (non-specific)

§ Anechoic, particulated fluid

§ Differentiate from dilated bladder; Obesity

§ Facilitates the sampling of fluid (ascites; urine)

Radiology

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