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50yo Chinese male Worsening abdominal distention (FLUID (ASCITES) (OTHER…

- - - - Cushing's syndrome
        
        Hx: progressive obesity/weight
        gain (face, neck, trunk, abdo.),
        decreased libido; obesity (primary),
        T2DM, women (25-45 YO), smoking
        (ectopic ACTH syndrome), family Hx.
        PE: round face, dorsal fat pad,
        ecchymoses, striae, skin atrophy,
        hyperpigmentation, prox. muscle
        wasting, HTN
      - Hypogonadism
        
        Hx: adult onset (decreased
        vigour & libido w/n days-weeks;
        infertility); LT use of high-dose
        glucocorticoids & sustainedrelease
        opiods, T2DM, end-stage
        renal disease, HIV. PE: gynaecomastia,
        decrease in size of
        testes
      - Hypothyroidism
        
        HX: progressive weight gain,
        fatigue, cold intolerance,
        constipation, dry skin, myalgia; older
        women, family Hx, Hx of
        thyroidectomy or external neck
        irradiation, drugs (Li, I). PE: goitre, bradycardia,
        HTN, reduced DTRs
      - Increased insulin resistance
      - CVD
    - - HX:Recent use of certain drugs/agents
        (psychoactive, antiepileptic,
        antihyperglycemic, hormones)
- - - - SAAG: SAAG can distinguish ascites from portal hypertension and nonportal hypertensive ascites. SAAG ≥1.1 g/dL reflects the presence of portal hypertension and indicates that the ascites is due to increased pressure in the hepatic sinusoids.) Possible causes include cirrhosis, cardiac ascites, hepatic vein thrombosis (Budd-Chiari syndrome), sinusoidal obstruction syndrome (veno-occlusive disease), or massive liver metastases. A SAAG <1.1 g/dL indicates that the ascites is not related to portal hypertension, as in tuberculous peritonitis, peritoneal carcinomatosis, or pancreatic ascites.