1
Third stage
Medicine
Lec-2
د
.
عماد
البدراني
1/1/2014
Fluid
4-associated feature with ascites include distortion or aversion of umbilicus and abdominal
striae ,diverication of recti and occasionally meralgia parsthetica and scrotal edema ,pleural
effusion can be found in 10%of pt. usually on Rt side most are small and only detected on
chest X-ray
Investigation:
1-Ultra sound is the best methods of confirming the ascites.
2-Radiographic; can show ascites but are insensitive and non-specific
3-Abdominal Paracentesis; Aspiration of fluid for analysis.
General appearance and color may help to identify the causes like: cirrhosis and H.F; clear,
or slight yellow
T.B-straw-color
Infection –cloudy
Malignant –bloody
Biliary communication –deep yellow bile staining
Lymphatic obstruction –milky –white
Two type of fluid in Aspiration
Exudate;
1-protein more than 30gm/l.
2-serum/ascitic proportion less than 1.5 .
3- cell more than 250/mm3.
4-causes infection, T.B, panceratitis, malignant, hypothyroidism.
Transudate; protein less than 30gm/l .2- serum/ascetic proportion more than 1.5 .3- cell
less than 250/mm3.
4- Causes, liver cirrhosis, H.F, nephritic synod.
Treatment:
1-treat the underlying causes.
2-Na and water retention.
3-diuretic –especially spironolacton (lactones).
Manifestation of renal diseases
1. Manifestations include symptoms and signs
2. Anatomy
3. Physiology
4. Main points
5. PAIN ; types of pains encountered in human being.
2
6. Renal pain
7. Ureteric pain
8. Urinary bladder pain
9. Regarding urination
1. Amount of urine…
Normal
Abnormal-polyuria
-oliguria
- anuria
-nocturia
2- dysuria
3- frequency
4- hesitancy
5- urgency
6- precipitancy
Color of urine
-normal
-abnormal
1- dark yellow urine
2- darkening on standing - porphyria,methyldopa,alcaptonuria
3- red urine - hematuria,hemoglobinuria,myoglobinuria,dyes(beet
root),drugs
Features related to urine voiding
1- enuresis
2- incontinence
3- retention
4- retention with over flow
General features related to renal disease
1- fever
2- vomiting
3- edema