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- Transudate (<3g protein in fluid) - heart failure, hypoalbuminaemia (nephrotic syndrome, liver failure), constrictive pericarditis
- Exudate (>3g protein in fluid) - malignancy (pancreatic cancer, colon cancer), infection (peritonitis), TB, Budd-Chiari syndrome (obstruction of the hepatic vein), myxoedema
- Chylous (milky white ascites) - malignant involvement of para-aortic lymph nodes by lymphoma, testicular tumour
- intraluminal: meconium ileus, intussusception, gallstones, colon cancer, faecal impaction;
- bowel wall: atresia, gut stenosis, Meckel's diverticulum, imperforate anus, bowel stricture, IBD, diverticulitis, colon cancer, endometriosis;
- extraluminal: abdominal abscess, tumour, adhesions (from previous surgery).
- Non-mechanical (bowel stops working for some reason) -
This is more seen as an abdominal mass, but your organs can get bigger: hepatomegaly, splenomegaly, bladdermegaly, stomachmegaly etc. (I may have made the last two up). The uterus also enlarges in fibroids.
Clinical and Associated Features
- Heart failure - orthopnoea (short of breath when lying down), PND, ankle oedema, tachycardia, pulsus alternans, reduced pulse volume, raised JVP, bibasal crackles, hepatomegaly, ascites
- Nephrotic syndrome - heavy proteinuria, hypoalbuminaemia, generalised oedema. Oedema - periorbital, genital, affected by gravity; transudative ascites; pleural effusions; abdominal discomfort, hypovolaemia, peritonitis; diarrhoea and vomiting; can present in kids
- Liver failure - ascites, jaundice, susceptibility to bleeding (haemorraghic diathesis), hepatic encephalopathy (neuro problems which get worse as the encephalopathy worsens)
- Percarditis - chest pain (substernal/precordial radiating to neck and shoulders, pain worsened by swallowing, inspiration, coughing, lying flat; fever; non-productive cough; weakness. Dyspnoea and orthopnoea are worse in tamponade.
- Fibroma - Meig's syndrome: fibroma, ascites and pleural effusion (weirdly mostly on the left).
- Cancer/IBD - weight loss, alternating constipation and diarrhoea, blood in stools, tiredness
- TB - weight loss, blood in stools, diarrhoea, tiredness, fever
- Budd-Chiari syndrome - ascites, jaundice, hepatomegaly and renal failure
- Mechanical - abdominal pain (usually cramp), vomiting (especially late in high obstructions), constipation, distention (especially with low obstruction)
- Non-mechanical (paralytic ileus - the bowel just ain't working baby) - no pain or tenderness, distention, no flatus or faeces, no bowel sounds, vomiting, high nasogastric output.