Background: Paracentesis is a common procedure for patients with decompensated cirrhosis. In patients with cirrhosis and superimposed renal impairment, clinicians may hesitate to perform a large volume paracentesis, given concerns of intraabdominal fluid shifts resulting in further renal dysfunction. In this study, we aimed to answer whether greater ascites fluid removal was associated with 48-hour [...]

Background: Paracentesis is associated with decreased mortality in patients with advanced liver disease. The prevalence of paracentesis related complications is not well characterized, but prior studies suggest improved safety outcomes when ultrasound guidance is employed.  The Agency for Healthcare Research and Quality utilizes patient safety indicator (PSI) 27 to identify postoperative bleeding complications. Our aim [...]

Background: Spontaneous bacterial peritonitis (SBP) is a commonly encountered complication of end stage liver disease that carries a high morbidity and mortality. Risk factors for SBP are defined by the American Association for the Study of Liver Diseases (AASLD) as a prior history of SBP, active gastrointestinal bleeding, and low ascites total protein (< 1.5 [...]

Background: Paracentesis is a commonly performed bedside procedure in hospitalized patients. It is often necessary for patients who are taking anticoagulant therapies and/or have disorders of hemostasis. Concerns about bleeding complications often lead to care delays, blood product transfusions, medication changes, and costly labs. Purpose: This study evaluates the safety and clinical outcomes for a [...]

Background: Patients with refractory ascites often require large volume paracentesis (LVP) on a frequent basis. Most of the studies examining the clinical effects of LVPs, however, have looked only at one-time procedures. In addition, patients with ascites commonly present to the emergency department or require hospital admission for this procedure, leading to high health-care utilization. Our [...]

Case Presentation: A 75 year-old man with recently diagnosed bladder cancer presented with fever and dyspnea, one month after a laparoscopic cystectomy, radical prostatectomy, lymph node dissection, and urinary diversion via ileal conduit. On arrival, he was febrile to 38.4 C, heart rate of 110 bpm, tachypneic on 2L supplemental oxygen. His abdomen was nontender [...]

Case Presentation: A 73-year-old woman with past medical history of hypertension, deep venous thrombosis and chronic kidney disease presented with nausea, vomiting, abdominal distension, weight loss and progressive deconditioning. Physical exam showed temporal wasting, abdominal distension with fluid wave, upper extremity sarcopenia, 3+ bilateral lower extremity edema, and generalized weakness impairing ability to walk. Creatinine [...]

Case Presentation: A 65-year-old man presented with anasarca and dyspnea on exertion that progressively worsened over three weeks. He had no known cardiac, renal, or liver disease prior to presentation. Physical exam revealed elevated jugular venous distention, bibasilar crackles, tense ascites, scrotal edema, and pitting edema in bilateral lower extremities extending to the abdomen. Investigation [...]

Case Presentation: A 49-year-old male presented for evaluation of an umbilical hernia. Past medical history was remarkable for alcohol misuse; the patient had ceased all alcohol consumption three years earlier. Physical exam revealed a protuberant, non-tender abdomen with a 4×4 cm reducible umbilical hernia. Pre-operative laboratory exam was remarkable for serum sodium of 137 mmol/L, [...]

Case Presentation: A 58 year old female with past medical history of microcytic hypochromic anemia and thrombocytosis presented with progressive abdominal distention and pedal edema of 5 months duration. There was no significant history of asbestos exposure.Initial diagnostic paracentesis and peritoneal fluid cytology was negative for malignant cells but showed atypical cells, but tumor markers [...]