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Paracentesis – procedure to remove fluid inside the abdomen.

Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites . Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.https://youtu.be/F1ZLWR_mYy8

Why It Is Done

Paracentesis may be done to:
  • Find the cause of fluid buildup in the belly.
  • Diagnose an infection in the peritoneal fluid.
  • Check for certain types of cancer, such as liver cancer.
  • Remove a large amount of fluid that is causing pain or trouble breathing or that is affecting how the kidneys or the intestines (bowel) are working.
  • Check for damage after a belly injury.

How To Prepare

Before you have paracentesis done, tell your doctor if you:
  • Are taking any medicine.
  • Are allergic to any medicines, including numbing medicines (anesthetics).
  • Have had bleeding problems or are taking blood thinners, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or warfarin (Coumadin).
  • Are or might be pregnant.
Other blood tests may be done before a paracentesis to make sure that you do not have any bleeding or clotting problems. You will empty your bladder before the procedure. You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean.

How It Is Done

This procedure may be done in your doctor’s office, an emergency room, or the X-ray department of a hospital, or at your bedside in the hospital.
If a large amount of fluid is going to be taken out during the procedure, you may lie on your back with your head raised. People who have less fluid taken out may sit up. The site where your doctor will put the needle is cleaned with a special soap and draped with sterile towels.Your doctor puts a numbing medicine into your belly. Once the area is numb, your doctor will gently and slowly put the paracentesis needle in where the extra fluid is likely to be. Your doctor will be careful to not poke any blood vessels or the intestines. If your test is done in the X-ray department, an ultrasound may be used to show where the fluid is in your belly. If a large amount of fluid is present, the paracentesis needle may be hooked by a small tube to a vacuum bottle for the fluid to drain into it. Generally, up to 4 L (1 gal) of fluid is taken out. If your doctor needs to remove a larger amount of fluid, you may be given fluids through an intravenous line (IV) in a vein in your arm. This fluid is needed to prevent low blood pressure or shock. It is important that you lie completely still during the procedure unless you are asked to change positions to help drain the fluid. When the fluid has drained, the needle is taken out and a bandage is placed over the site. After the test, your pulse, blood pressure, and temperature are watched for about an hour. You may be weighed and the distance around your belly may be measured before and after the test. Paracentesis takes about 20 to 30 minutes. It will take longer if a large amount of fluid is taken out. You can do your normal activities after the test unless your doctor tells you not to.

How It Feels

You may feel a brief, sharp sting when the numbing medicine is given. When the paracentesis needle is put into your belly, you may feel a temporary sharp pain or pressure.
You may feel dizzy or lightheaded if a large amount of fluid is taken out. Tell your doctor if you do not feel well during the test.After the procedure, you may have some clear fluid draining from the site, especially if a large amount of fluid was taken out. The drainage will get less in 1 to 2 days. A small gauze pad and bandage may be needed. Ask your doctor how much drainage to expect.

Risks

There is a very small chance that the paracentesis needle may poke the bladder, bowel, or a blood vessel in the belly. If cancer cells are present in the peritoneal fluid, there is a small chance that the cancer cells may be spread in the belly. If a large amount of fluid is removed, there is a small chance that your blood pressure could drop to a low level. This could lead to shock. If you go into shock, IV fluids or medicines, or both, may be given to help return your blood pressure to normal. There is also a small chance that removing the peritoneal fluid may affect how your kidneys work. If this is a concern, IV fluids may be given during the paracentesis.

After the test Call your doctor immediately if you have:

  • A fever higher than 100°F (38°C).
  • Severe belly pain.
  • More redness or tenderness in your belly.
  • Blood in your urine.
  • Bleeding or a lot of drainage from the site.

Results

Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites . The fluid taken from your belly will be sent to a lab to be studied and looked at under a microscope. Results will be ready in a few hours.
Paracentesis
Normal: No infection, cancer, or abnormal values are found.
Abnormal: Several tests may be done on the fluid.
  • Cell counts. A high number of white blood cells (WBCs) in the fluid may mean inflammation, infection (peritonitis), or cancer is present. A high WBC count and a high count of WBCs called polymorphonuclear leukocytes (PMNs) may mean there is an infection inside the belly called spontaneous bacterial peritonitis (SBP).
  • Serum-ascites albumin gradient (SAAG). The SAAG compares the level of protein in the fluid to the level of protein in the blood. High protein levels in the fluid may mean cancer,tuberculosisnephrotic syndrome, orpancreatitis. Low protein levels in the fluid may mean cirrhosis or clots in veins of the liver are present.
  • Culture. A culture can be done on the fluid to see whether bacteria or other infectious organisms are present.
  • Lactate dehydrogenase (LDH). High levels of the enzyme LDH may mean infection or cancer is present.
  • Cytology. Abnormal cells in the fluid may mean cancer is present.
  • Amylase. High levels of amylase may mean pancreatitis or that there is a hole in the intestine.
  • Glucose. Low levels of glucose may mean infection.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:
  • Using blood thinners (anticoagulants) or aspirin, which can increase the chance of bleeding.
  • Having blood, bile, urine, or feces in the fluid sample.
  • Not being able to stay still during the test.
  • Being obese.
  • Having scars inside the belly (adhesions) from any belly surgery in the past.

What To Think About

Sometimes doctors use fluids put into the belly to check for injuries. This is called peritoneal lavage. During this procedure, a doctor uses a paracentesis needle to put a salt (saline) fluid into the belly. The fluid is then taken out through the same needle. If the fluid that comes out is bloody, the bleeding is probably being caused by an injury inside the belly.

Abdominal Pain – inside the mind of a doctor

Abdominal pain is very scary,  there are a few diagnosis that we are very concerned about.   Like when someone shows up with appendicitis,  because there is potential for many bad illnesses. For example: appendicitis,  diverticulitis, a bowel obstruction,  abdominal aortic aneurysm, a spontaneous rupture of the bowel, etc.   There are many diagnoses that are potentially very serious and severe, some of them potentially surgical diseases  that we as physicians are going to worry about when we see someone with abdominal pain. So I am going to take you inside the mind of an emergency medicine doctor,  and how we try to figure out the cause of the abdominal pain. When I mention of specific diagnosis, I suggest she go to www.patienteducation.Video and search and find that specific diagnosis  and view the specific video on that subject.   Not all  these videos are made by me,  others are by other physicians, and other websites to better educate you better. First we going to ask the patient about the ‘character’ of the pain and help define it better. We are going to start  with the location of the pain. Where is it located? We divide the abdomen into 4 quadrants: RUQ – right upper quadrant LUQ – left upper quadrant RLQ – right lower quadrant LLQ – left lower quadrant That is going to help us zone in  the underlying structures of that particular quadrant.  For example, in the RUQ you have the liver and gallbladder, also the kidney posteriorly and part of the duodenum (bowel).  On the LUQ you will find not much there, you have kidney, bowel, and the spleen.  On the LLQ you will find diverticula, bowel (which can cause colitis) if you are female then also ovaries, fallopian tubes, and uterus. And finally on the RLQ there is the appendix, but also other diseases like mesenteric adenitis, kidney stones, of course female related problems.         screen-shot-2016-07-20-at-9-31-52-am Dr. Carlo Oller Board Certified Emergency Physician Please visit my website, www.DrER.tv make sure you subscribe, comment, and share! That is the best way to show your support.  

Ascites – fluid in the abdomen due to liver failure

Dr. Carlo Oller talks about the causes of ascites.

What is fluid in the belly? — “Fluid in the belly” happens when fluid collects in the space between the organs in the belly and the belly wall. The word doctors use for fluid in the belly is “ascites.”

What causes fluid in the belly? — The most common cause of fluid in the belly is a liver condition called “cirrhosis.” Cirrhosis is a disease that scars the liver. The liver is a big organ in the upper right side of the belly. Cirrhosis is usually caused by heavy alcohol use or certain liver infections.

Other causes of fluid in the belly are not as common, but can include heart problems, cancer, and certain infections.

What symptoms does fluid in the belly cause? — Fluid in the belly can cause:

A big belly, which can lead to belly pain – The belly usually gets bigger over a short period of time.

Weight gain

Trouble breathing

Feeling full after eating only a small amount of food

Sometimes, the fluid in the belly can get infected. This can cause worse belly pain, fever, and sometimes confusion. If you have fluid in your belly and then get any of these symptoms, see your doctor right away.

Will I need tests? — Yes. To look for fluid in your belly, your doctor will do an imaging test such as an ultrasound or CT scan. Imaging tests create pictures of the inside of the body.

Many people also have a procedure called “paracentesis.” For this procedure, your doctor will put a needle into your belly and into the collection of fluid. (He or she will numb the area of skin where the needle goes in.) Your doctor will remove a sample of fluid and send it to a lab for tests. These tests can show what’s causing the fluid to collect and if the fluid is infected.

How is fluid in the belly treated? — Treatment depends partly on what’s causing the fluid to collect and how severe your condition is.

If you have cirrhosis, your treatment will probably involve:

Following a low-salt (also called “low-sodium”) diet – This can help reduce the amount of fluid in your belly.

Taking a medicine called a “diuretic” – Diuretics make people urinate much more than usual.

Stopping your alcohol use (if you drink alcohol)

Avoiding medicines called “NSAIDs” that can harm the liver – NSAIDs are a group of medicines that includes aspirin, ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand name: Aleve).

Checking your weight every day – Following your weight will help your doctor monitor your condition.

Treatment also depends on your symptoms. If you have severe symptoms, symptoms that don’t get better with treatment, or symptoms that come back after treatment, you might need to have:

Paracentesis to remove a large amount of fluid

A procedure called “TIPS” in which a doctor puts a device in your liver that reduces fluid build-up

Both of these treatments can help improve your symptoms so you feel better. If you have severe liver disease, your doctor will talk with you about the possibility of having a liver transplant. A liver transplant is surgery in which a doctor replaces a diseased liver with a healthy liver.

How can I prevent more fluid from collecting in my belly? — You can help prevent more fluid from collecting by following all of your doctor’s instructions about treatment.

Let your doctor or nurse know if you are having trouble following the treatment plan. For example, if you are having trouble following a low-salt diet, your doctor or nurse can recommend a dietitian (food expert) to help you.
Dr. Carlo Oller Board Certified Emergency Physician Please visit my website, www.DrER.tv make sure you subscribe, comment, and share! That is the best way to show your support.

Pancreatitis – Pancreas Inflammation

The pancreas is an organ located behind the stomach that produces chemicals called enzymes, as well as the hormones insulin and glucagon. Most of the time, the enzymes are only active after they reach the small intestine, where they are needed to digest food. When these enzymes somehow become active inside the pancreas, they eat (and digest) the tissue of the pancreas. This causes swelling, bleeding (hemorrhage), and damage to the pancreas and its blood vessels. Acute pancreatitis affects men more often than women. Certain diseases, surgeries, and habits make you more likely to develop this condition.

Diverticulitis

What is diverticulitis?

— Diverticulitis is a disorder that can cause belly pain, fever, and problems with bowel movements.

The food we eat travels from the stomach through a long tube called the intestine. The last part of that tube is the colon. The colon sometimes has small pouches in its walls. These pouches are called “diverticula.” Many people who have these pouches have no symptoms. Diverticulitis happens when these pouches develop a small tear also known as a “microperforation,” which then become infected and cause symptoms.

What are the symptoms of diverticulitis?

— The most common symptom of diverticulitis is pain, which is usually in the lower part of the belly. Other symptoms can include:

Fever

Constipation

Diarrhea

Nausea and vomiting

Is there a test for diverticulitis? — Yes. There are a few tests your doctor or nurse can do to find out if you have diverticulitis. But tests are not always needed. Your doctor or nurse might be able to diagnose you without them. If you do have a test, you might have a:

CT scan – A CT scan is a kind of imaging test. Imaging tests create pictures of the inside of your body.

Abdominal ultrasound – This test uses sound waves to create pictures of your intestines.

How is diverticulitis treated?

— That depends on how bad your symptoms are. If you have mild symptoms, your doctor or nurse will put you on antibiotics and might put you on a clear liquid diet for a short time. That might be all the treatment you need.

But if you have severe symptoms, or if you get a fever, you might need to stay in the hospital. There, you can get fluids and antibiotics through a thin tube that goes into your vein, called an “IV.” That way you can stop eating and drinking until you get better. If you have a serious infection, the doctor might put a tube into your belly to drain the infection. In very bad cases, people need surgery to remove the part of the colon that is affected. A few months after your infection has been treated, your doctor might recommend that you have a procedure called a colonoscopy. During a colonoscopy, the doctor can look directly inside your colon to get an idea of the number of diverticula in your colon and to find out where they are. At the same time, he or she can check for signs of cancer.

Should I change my diet if I have had diverticulitis? — If you have had diverticulitis, it’s a good idea to eat a lot of fiber. Good sources of fiber include fruits, oats, beans, peas, and green leafy vegetables. If you do not already eat fiber-rich foods, wait until after your symptoms get better to start.

You do not need to avoid seeds, nuts, popcorn, or other similar foods.
  • Carlo Oller (emergency physician with www.DrER.tv) has put together more than 1800 FREE patient education videos which can be found at www.patienteducation.video
  • Please contact Dr. Carlo Oller at carlooller@gmail.com if you would like to use his videos in your own website, or educational materials. Or if you would like some more information or education on a title NOT available at this time.

Abdominal Pain NOS (not otherwise specified) – Unknown Cause

This is defined as ‘pain for which no immediate cause can be found (during the acute admission) and specifically does not require surgical intervention’. NSAP may be self-limiting and accounts for 13–40% of all surgical admissions. The abdomen can be subdivided into regions (picture on the left) or into quadrants (picture on the right) to help standardize the description of the location of the pain between providers. The location of the pain will help drive the clinician’s differential diagnosis and therefore the tests needed. The most frequent cause of abdominal pain is gastroenteritis (13%), irritable bowel syndrome (8%), urinary tract problems (5%), inflammation of the stomach (5%) and constipation (5%).