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Spontaneous Bacterial Peritonitis

Dr Swapnil Pawar December 22, 2020 219


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    Spontaneous Bacterial Peritonitis
    Dr Swapnil Pawar

Post written by – Dr Andrew Lam

SAAG

Serum Albumin – Albumin of Ascitic Fluid

High SAAG (>11g/L)
Suggests that the cause of ascites is related to portal hypertension

Causes:
Cirrhosis
Hepatic malignancy or metastasis
Right-Sided Cardiac Failure
Portal Vein Thrombosis
Budd-Chiari Syndrome

Low SAAG (<11g/L)
Suggests that cause of ascites is NOT related to portal hypertension

Causes:
Pancreatitis
Peritoneal metastasis
Nephrotic Syndrome
Tuberculosis

Hepatic Encephalopathy

Can be classified by the West Haven Criteria: 

Grade Criteria
0
  • Nil obvious changes clinically
  • On formal psychometric or neuropsychological tests, may have some minor dysfunction
1
  • Trivial lack of awareness
  • Disrupted sleep/wake cycle
  • Shortened attention span 
  • Anxiety or euphoria
2
  • Lethargy and Apathy
  • Moderate confusion
  • Personality changes/Inappropriate Behaviour
  • Asterixis
3
  • Marked confusion
  • Stuporous
  • Incoherent speech 
  • Gross disorientation
4
  • Comatose

 

Types of Hepatic Encephalopathy

Type A (Acute) – Hepatic encephalopathy associated with acute liver failure 

Type B (Bypass) – Hepatic encephalopathy associated with portosystemic shunting in the ABSENCE of liver disease

Type C (Cirrhosis) – Hepatic encephalopathy associated with cirrhosis with resulting portal hypertension or systemic shunting 

Wernicke-Korsakoff Syndrome

Develops as a result of thiamine (Vitamin B1) Deficiency, and refers to two separate stages of the disease:

Wernicke’s Encephalopathy: Acute syndrome that requires treatment to prevent further neurological morbidity. Classified by the triad of:

  • Encephalopathy (confusion, apathy, inattentiveness)
  • Ataxia
  • Ophthalmoplegia/Nystagmus

 

Korsakoff’s Syndrome: A chronic neurological condition that comes as a result of untreated Wernicke’s Encephalopathy. Characterised by: 

  • Anterograde and retrograde amnesia
  • Confabulation
  • Relative preservation of attention and social behaviour

 

References: 

Ferenci, P. (2020), Hepatic Encephalopathy in Adults: Clinical Manifestations and Diagnosis. UpToDate. Retrieved November 21, 2020 from https://www.uptodate.com.acs.hcn.com.au/contents/hepatic-encephalopathy-in-adults-clinical-manifestations-and-diagnosis 

Runyon, B.A. (2020), Evaluation of Adults with Ascites. UpToDate. Retrieved November 21, 2020 from https://www.uptodate.com.acs.hcn.com.au/contents/evaluation-of-adults-with-ascites

Yuen, T.S. (2020), Wernicke Encephalopathy. UpToDate. Retrieved November 21, 2020 from https://www.uptodate.com.acs.hcn.com.au/contents/wernicke-encephalopathy

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Post-Operative Fluid Management

Dr Swapnil Pawar December 17, 2020

Post-op Fluids Written by Dr Hyerim Su Daily requirements of electrolytes and water  Water – 25mL/kg/day  Sodium – 1.0mmol/kg/day  Potassium – 1.0mmol/kg/day  Glucose 50g/day  Table 1. Composition of intravenous fluids […]

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