Podcasts about pleurx

Episode 200: All About Ascites.     Jesica Mendoza explains the pathophysiology, diagnosis and management of ascites. Dr. Arreaza adds input about early detection and prevention of spontaneous bacterial peritonitis. Written by Jesica Mendoza, OMS IV, Western University, College of Osteopathic Medicine of the Pacific. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Welcome to our episode 200! It is an honor to welcome back a wonderful medical student, her name is Jesica, and she has prepared this topic, and she is excited to share this information with us. Jesica presented in June this year an episode about gestational diabetes (episode 193) and today she will talk about ascites. Jesica, please tell us who you are again. What is ascites?Ascites is the buildup of fluid in between the visceral peritoneum and the parietal peritoneum in the abdomen. This is often caused by cirrhosis of the liver due to the increased portal HTN which leads to increased nitrous oxide (NO) and prostaglandins which then causes splanchnic vasodilation and decreased effective arterial volume. The decrease in arterial volume then causes an increase in the renin–angiotensin–aldosterone system (RAAS) and antidiuretic hormone (ADH) from the renal system which leads to sodium and water retention. This then causes a net reabsorption of fluids and ascites.Evaluation of ascites.Once someone has been found to have ascites the next step will be a diagnostic paracentesis. This includes removing fluid from the peritoneal cavity in order to determine the SAAG (Serum Ascites Albumin Gradient) score. SAAG : (serum albumin) − (albumin level of ascitic fluid). The two values should be measured at the same time.This score helps determine the cause of the ascites with a score >1.1 g/dL indicating portal hypertension usually due to liver disease such as cirrhosis. A SAAG score of 250 PMNS/mL. Fluid should be sent to the lab for culture and then antibiotics should be started. IV 3rd generation cephalosporins are typically used. Fluoroquinolones are also used to prevent the recurrence of SBP.If you desire to learn more about SBP, listen to our episode 123. By the way, propranolol is a frequently used medication to prevent GI bleeding from esophageal varices in cirrhosis and also to decrease the development of ascites. It should be used in patients who have compensated cirrhosis and must be avoided in patients with refractory ascites, hypotension, renal dysfunction or active infection. So, to wrap things up we should remember that once we identify ascites with our physical exam of the patient, we should make sure to obtain a paracentesis as these results will be the main guide for our treatment. The treatment can then range from medical treatment such as spironolactone and/or loop diuretics to TIPS procedures, PleurX or even liver transplant. Always be on the lookout for SBP in patients with ascites and always remember to obtain a culture on the ascitic fluid prior to starting antibiotics. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Ascites, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/14792-ascites.Huang LL, Xia HH, Zhu SL. Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites. J Clin Transl Hepatol. 2014 Mar;2(1):58-64. doi: 10.14218/JCTH.2013.00010. Epub 2014 Mar 15. PMID: 26357618; PMCID: PMC4521252. https://pmc.ncbi.nlm.nih.gov/articles/PMC4521252/.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Dr. Jed Gorden reviews the technique of pleurodesis to manage the complication of recurrent malignant pleural effusion (MPE).

Dr. Jed Gorden reviews the technique of pleurodesis to manage the complication of recurrent malignant pleural effusion (MPE).

Dr. Jed Gorden reviews the technique of pleurodesis to manage the complication of recurrent malignant pleural effusion (MPE).

A tunneled pleural catheter is an excellent way to manage the symptoms of a recurrent malignant pleural effusion. Dr. Jed Gorden describes how it is placed and how it works.

A tunneled pleural catheter is an excellent way to manage the symptoms of a recurrent malignant pleural effusion. Dr. Jed Gorden describes how it is placed and how it works.

A tunneled pleural catheter is an excellent way to manage the symptoms of a recurrent malignant pleural effusion. Dr. Jed Gorden describes how it is placed and how it works.

Dr. Jed Gorden describes the details of how a thoracentesis is performed in order to clarify the diagnosis and treat symptoms of a malignant pleural effusion (MPE).

Dr. Jed Gorden describes the details of how a thoracentesis is performed in order to clarify the diagnosis and treat symptoms of a malignant pleural effusion (MPE).

Dr. Jed Gorden describes the details of how a thoracentesis is performed in order to clarify the diagnosis and treat symptoms of a malignant pleural effusion (MPE).

Interventional pulmonologist Dr. Jed Gorden reviews malignant pleural effusions (MPEs) are a common complication of lung cancer and some other cancers.

Interventional pulmonologist Dr. Jed Gorden reviews malignant pleural effusions (MPEs) are a common complication of lung cancer and some other cancers.

Interventional pulmonologist Dr. Jed Gorden reviews malignant pleural effusions (MPEs) are a common complication of lung cancer and some other cancers.

This video teaches PleurX patients how to drain using the PleurX system.

This video features a suggested placement prcedure for the PleurX pleural catheter system for the management of recurrent pleural effusions.

This video features a suggested placement procedure for the PleurX peritoneal catheter system for the management of malignant ascites.