Case 10 Gastroenterology

Ascites

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

You are rotating on the Procedure Service and your team is asked to perform a routine “therapeutic” paracentesis on a patient with cancer. You walk into the room to meet the patient and this is what you see. This finding should generate a hypothesis.

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Clue 2

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Clue 3

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A “diagnostic” paracentesis wasn’t requested, but the underlying cause of ascites in this case has never been questioned. You consult your framework for ascites: The first question you want to know is whether the process is driven by portal hypertension or not.

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