A 55-year-old patient is admitted with an exacerbation of chronic liver disease. Results of an ascitic tap and serum results are listed below:
ASCITIC FLUID |
|
Parameter |
Patient Value |
Appearance |
Clear Yellow |
pH |
micro-clots present, no value obtained |
Red Cell Count |
0 erythrocytes/µL |
White Cell Count |
378 leukocytes/µL |
Ascitic Fluid Protein |
25 g/L |
Ascitic Fluid Albumin |
18 g/L |
Ascitic Fluid Lactic Acid Dehydrogenase (LOH) |
480 U/L |
Gram Stain |
no organisms seen |
SERUM |
|||||
Parameter |
Patient Value |
Adult Normal Range |
|||
Serum |
Protein |
32 g/L* |
60-80 |
||
Serum |
Albumin |
23 g/L* |
35-50 |
||
Serum Lactic Acid Dehydrogenase (LOH) |
320 U/L* |
120- 250 |
a) List four possible underlying diagnoses. (20% marks)
Spontaneous bacterial peritonitis
Perforated viscus
Cirrhosis
Malignancy
TB
Carrying on with theme for Question 5, this is another middle-aged gentleman with liver disease. This time, the question really is, "what does this ascitic tap mean". The history offered with the results ("exacerbation of liver disease"?) is so uninformative it may as well not exist.
So: using the 2009 article by Koulaouzidis and Such & Runyon (1998) as the main sources, one can concoct an unordered list which describes the reported findings, and their possible meaning.
So, in summary, what could this be?
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