The Clinical Problem Solvers Episode – 399 – RLR – Ascites
Jun 2, 2025
The hosts share amusing pet anecdotes, setting a light conversational tone. They dive deep into ascites and chylous effusion, discussing fluid analysis methods. A case study features a 64-year-old man with bilateral hydronephrosis, exploring complex differential diagnoses. The critical evaluation of a chest x-ray reveals intriguing connections to heart and lymphatic issues. They also tackle a challenging case with idiopathic ureteral stenosis, highlighting the importance of teamwork and open dialogue among medical professionals.
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Initial Fluid Collection Anecdote
- Robbie first saw two colleagues collecting a large volume of fluid from the peritoneal space in the emergency room.
- The fluid was nearly bloody and milky, sparking an initial suspicion of chylous ascites.
Milky Fluid Indicates Chylous Ascites
- Milky fluid that separates into layers suggests chylous ascites with high triglycerides.
- This fluid is often lymphocyte predominant and indicates lymphatic disruption.
High SAG in Chylous Ascites Explained
- A serum ascites albumin gradient (SAG) above 1.1 suggests portal hypertension; below indicates exudative causes.
- This case had high SAG despite milky fluid, implying precise lymphatic leakage without widespread endothelial disruption.