Chylous Ascites

CHYLOUS ASCITES 1.

CHIEF COMPLAINT a. Chylous ascites

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HPI

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ROS

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SYMPTOMS a. Abdominal distension b. Abdominal pain c. Anorexia d. Weight loss e. Edema f. Weakness g. Nausea h. Dyspnea i. Weight gain j. Lymphadenopathy k. Early satiety l. Fever m. Night sweats

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HISTORY a. FAMILY HISTORY b. SOCIAL HISTORY c. PAST MEDICAL HISTORY •Hepatoma •small bowel lymphoma •small bowel angiosarcoma •retroperitoneal lymphoma •Spontaneous bacterial peritonitis •Pelvic irradiation •Peritoneal dialysis d. SURGICAL HISTORY •Abdominal surgery •Blunt abdominal trauma e. CHRONIC CONDITIONS •Cirrhosis •Abdominal tuberculosis

•Carcinoid syndrome •Congenital defects of lacteal formation 6.

ALLERGIES

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PHYSICAL EXAMINATION

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SPECIFIC DATA LIKE GRADING ETC •True chylous ascites - Fluid with high triglyceride content •Chyliform ascites - Fluid with a lecithin-globulin complex due to fatty degeneration of cells •Pseudochylous ascites - Fluid that is milky in appearance due to the presence of pus

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TESTS TO BE ORDERED •CBP •ESR •Liver function tests •Serum albumin •Serum electrolytes •Ascitic fluid study •USG abdomen •CT scan •Lymph node biopsy •Laparotomy •Lymphangiography •Barium studies of the gastrointestinal tract •Bone marrow examination •Intravenous pyelography •MRI

10. ASSESSMENT /PLAN •A low-fat diet with medium-chain triglyceride supplementation •Paracentesis •Peritoneovenous shunting 11. EDUCATION 12. MEDICATION •Orlistat

•Octreotide 13. FOLLOW UP