Speaker Credentials
MS-III
Speaker Credentials
BS
College
College of Allopathic Medicine
Medical Specialty
Internal Medicine
Format
Poster
Start Date
November 2024
End Date
November 2024
Track
2
Abstract
Introduction. Our objective in discussing this case is to explore an approach to the various etiologies of ascites, thereby encouraging clinicians to consider extrahepatic differentials during disease management. To do so, we examined the following case of ascites in the setting of underlying malignancy. Case Presentation. An 85-year-old female presented with rapid-onset abdominal distension as well as dark stools and shortness of breath. She had also experienced progressive weakness, malaise, and weight loss over the last year. Past medical history was notable for endometriosis, hyperlipidemia, and xanthogranulomatous pyelonephritis. She was mildly tachycardic on admission. Labs were notable for leukocytosis with neutrophilic predominance, thrombophilia, and elevated pro-brain natriuretic peptide (pro-BNP). Urinalysis demonstrated evidence of urinary tract infection, and stool occult blood test was positive. Chest X-ray revealed left pleural effusion, while CT of the abdomen confirmed marked ascites. Deviation from the Expected. Paracentesis was performed, revealing cloudy fluid with a serum-ascites albumin gap (SAAG) of 0.7 g/dL, suggesting an origin unrelated to portal hypertension. Tumor marker testing was positive for elevated CA-125, and cytology confirmed presence of cells consistent with ovarian adenocarcinoma. Discussion. In this case, we discussed the role of an open-minded approach, combined with utilization of diagnostic paracentesis and fluid cytology, in considering causes of ascites both related and unrelated to portal hypertension. Conclusion. We believe this method of diagnostic evaluation will promote early detection and treatment of less common origins of ascites, particularly those related to malignancy, in the interest of more efficient and goal-oriented patient care.
Poster
Included in
Internal Medicine Commons, Medical Pathology Commons, Neoplasms Commons, Pathological Conditions, Signs and Symptoms Commons, Physiological Processes Commons
Malignancy-Related Ascites: Thinking Outside the Liver
Introduction. Our objective in discussing this case is to explore an approach to the various etiologies of ascites, thereby encouraging clinicians to consider extrahepatic differentials during disease management. To do so, we examined the following case of ascites in the setting of underlying malignancy. Case Presentation. An 85-year-old female presented with rapid-onset abdominal distension as well as dark stools and shortness of breath. She had also experienced progressive weakness, malaise, and weight loss over the last year. Past medical history was notable for endometriosis, hyperlipidemia, and xanthogranulomatous pyelonephritis. She was mildly tachycardic on admission. Labs were notable for leukocytosis with neutrophilic predominance, thrombophilia, and elevated pro-brain natriuretic peptide (pro-BNP). Urinalysis demonstrated evidence of urinary tract infection, and stool occult blood test was positive. Chest X-ray revealed left pleural effusion, while CT of the abdomen confirmed marked ascites. Deviation from the Expected. Paracentesis was performed, revealing cloudy fluid with a serum-ascites albumin gap (SAAG) of 0.7 g/dL, suggesting an origin unrelated to portal hypertension. Tumor marker testing was positive for elevated CA-125, and cytology confirmed presence of cells consistent with ovarian adenocarcinoma. Discussion. In this case, we discussed the role of an open-minded approach, combined with utilization of diagnostic paracentesis and fluid cytology, in considering causes of ascites both related and unrelated to portal hypertension. Conclusion. We believe this method of diagnostic evaluation will promote early detection and treatment of less common origins of ascites, particularly those related to malignancy, in the interest of more efficient and goal-oriented patient care.