Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

162 Ascariasis Ascites

follow-up

Routine

■Stool O&P 2 or more weeks after treatment

complications and prognosis

■Worms in biliary tree may cause symptoms of cholecystitis; more

rarely, pancreatitis occurs from worms in pancreatic duct. Intestinal

obstruction may occur in small children.

■Worms in biliary or pancreatic systems may necessitate surgery.

Intestinal obstruction requires surgery.

Ascites............................................

ANDY S. YU, MD and EMMET B. KEEFFE, MD

history & physical

History

■Risk factors for liver disease: excessive alcohol consumption, injec-

tion drug use, blood transfusion, multiple sexual partners, occupa-

tional exposure, Asian country of origin, family history

■Risk factors for nonhepatic causes of ascites: TB, cancer

Signs & Symptoms

■Lower extremity edema; anasarca

■Physical findings of chronic liver disease: firm liver, splenomegaly,

jaundice, gynecomastia, vascular spiders, palmar erythema, asterixis

■Physical findings of heart disease: abnormal jugular venous disten-

tion

■Physical findings indicative of malignancy: nodule in umbilicus or

supraclavicular region

tests

Basic Tests

■Ascitic fluid cell count:

➣Neutrophil count >250/mm3 presumed to be infection

➣Tuberculous peritonitis & peritoneal carcinomatosis predomi-

nantly lymphocytic WBC count

■Ascitic fluid albumin to calculate serum-ascites albumin gradient

(SAAG) (serum albumin minus ascitic fluid albumin)