Budi prakoso

Abdominal swelling
Manifestasi dr bbg penyakit penambahan lingkar

perut
Sering tnp nyeri, jk nyeri infeksi
Hernia +
Dyspnue tek diafragma

Penyebab
Flatus pe gas , N small intestine 200cc N, O2,

CO2, H2 dan methane

Aerofagia , metabolisme bakteri
Fat obesitas, cushing syndrome insulin
resistance, kardiovaskuler
Fluid
Fetus
Feces konstipasi, obstruksi intestin
Fatal growth malignancy

History and physical examination

History
malignancy wight loss, night sweats, anorexia
pass stool, flatus, nausea, vomiting obstruksi,

konstipasi berat, ileus

Chronic liver disease alkoho, jaundice, asscites
Peny dhl CHF, TBC

Pemeriksaan fisik
Lymphadopathy
JVP
Kusmaul, murmur,

Spyder angioma, palmar erythema. Caput medusa,

gynecomastia
Abdomenmassa, distensi, auskultasitanda ileus,
bruit pd liver (malignancy)
Bedakan gas dgn cairan ascitesperkusi, min 1500cc
Palpasi tendernes, besar liver spleen, nodular

Imaging and laboratorium

Abd X raydilatasi ususobstruksi, ileus
USG100cc ascites, hepatoslenomegali, nodul liver,

masa, sulit u/ lesi pancreasCtscancirrhosis, portal

HT
Laboratoryalbumin, PTT, CBC, amilase, lipase,
protein urine
Liver biopsi

Ascites
Pathogenesis pd cirrhosisportal HT dan retensi

garam dan air

Portal HTfibrosis hati kerusakan hepatic sinusoid.
Aktivasi sel stelata fibrogenesis, kontraksi sm,
fibrosis.
pe NOS intrahepatic NO, pevasokontriksi
intrahepatic
PeNO sistemik

Patogenesis selain cirrhosis

Peritoneal carcinomatosis, peritoneal infeksi, peny

pancreas.
Peritoneal Camesothelioma, sarcoma, adenoca
gastric colon, metastase ca mamma, paru, melanoma

Penyebab
>> cirrhosis 84%
Cardiac ascites
Peritoneal carcinomatosis

Masive hepatic metastasis

Infeksi (TB)
Pancreatitis
Nephrotic syndrome

Evaluasi
Paracentesis etiologi, lokasi left lower quadrant,

infraumbilical.
Pemeriksaan kasar
Putih, spt susuTG>> (200-1000mg/dl)chylous
asciteskerusakan sal lymphatictrauma, cirrhosis,
tumor, tb, kel kongenital
Dark brown bil perforasi bil tract
Black fluidnekrosis pankreas, metastase melanoma

 Kadar albumin, total protein, sel dan diffcount,

pengecatan, kultur
SAAG ( serum-ascites albumin gradient)
SAAG > 1,1g/dL portal HT
SAAG < 1,1 g/dL selain portal HT
BNP gagal jantung
Glukosa, LDH multiple patogen, amilase, cytology

Diagnosis ascites berdasar SAAG