Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 157: A 44-Year-Old with Cirrhosis and Shortness of Breath
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Jul 31, 2025 Dive into a captivating clinical case about a 44-year-old woman grappling with cirrhosis and shortness of breath. The discussion unravels the complexities of pleural effusions, highlighting how to differentiate between exudates and transudates using Light's criteria. Listeners gain insights into vital signs, imaging, and diagnostic reasoning that enhance their understanding of internal medicine. Treatment strategies for hepatic hydrothorax and the implications of liver failure are key highlights that offer valuable learning for medical enthusiasts.
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Light's Criteria for Effusions
- Light's criteria help distinguish exudative versus transudative pleural effusions based on protein and LDH ratios.
- They are very accurate for exudates but can misclassify 25% of transudates, requiring gradient checks for confirmation.
Hepatic Hydrothorax Mechanism
- Hepatic hydrothorax occurs when ascites fluid tracks through diaphragmatic defects into the pleural space, usually on the right side.
- This pleural effusion mimics ascites and is typically a transudate with low protein content.
Treating Hepatic Hydrothorax
- Treat hepatic hydrothorax like ascites using volume control and therapies to reduce portal pressure.
- Rarely, pleurodesis may be required if medical management fails.
