Hepatic hydrothorax is a relatively infrequent but po- tentially serious complication of liver cirrhosis that often causes respiratory dysfunction. Several hypotheses for the development of hepatic hydrothorax have be...Hepatic hydrothorax is a relatively infrequent but po- tentially serious complication of liver cirrhosis that often causes respiratory dysfunction. Several hypotheses for the development of hepatic hydrothorax have been sug- gested to explain a transdiaphragmatic shift of ascitic fluid through small defects between the peritoneal cavity and the pleural space. However, the rapid development of hydrothorax within several hours is seldom encoun- tered. In addition, the causal factors for rapid passage of ascitic fluid into the pleural cavity are unknown. This report describes a patient with liver cirrhosis who suf- fered rapid development of a hydrothorax after manual compression of the abdomen.展开更多
Because decompensated heart failure(HF)patients present primarily with symptoms of congestion,the assessment of volume status is of paramount importance.Despite the addition of new technologies that can predict intrac...Because decompensated heart failure(HF)patients present primarily with symptoms of congestion,the assessment of volume status is of paramount importance.Despite the addition of new technologies that can predict intracardiac filling pressures,the physical exam(PE)remains the most accessible and cost-effective tool available to clinicians.An elevated jugular venous pressure(JVP) is considered the most sensitive sign of volume overload,although the commonly used‘method of Lewis’has several limitations.A useful cutoff is that if the JVP is greater than 3 cm in vertical distance above the sternal angle,the central venous pressure is elevated.In addition to assessment of volume status,the PE in HF can reveal adverse prognostic signs,namely:elevated JVP,presence of third heart sound,elevated heart rate,low systolic BP,and low proportional pulse pressure(＜25%).This article will review the evidence for the diagnostic and prognostic utility of common PE findings in HF.展开更多
文摘Hepatic hydrothorax is a relatively infrequent but po- tentially serious complication of liver cirrhosis that often causes respiratory dysfunction. Several hypotheses for the development of hepatic hydrothorax have been sug- gested to explain a transdiaphragmatic shift of ascitic fluid through small defects between the peritoneal cavity and the pleural space. However, the rapid development of hydrothorax within several hours is seldom encoun- tered. In addition, the causal factors for rapid passage of ascitic fluid into the pleural cavity are unknown. This report describes a patient with liver cirrhosis who suf- fered rapid development of a hydrothorax after manual compression of the abdomen.
文摘Because decompensated heart failure(HF)patients present primarily with symptoms of congestion,the assessment of volume status is of paramount importance.Despite the addition of new technologies that can predict intracardiac filling pressures,the physical exam(PE)remains the most accessible and cost-effective tool available to clinicians.An elevated jugular venous pressure(JVP) is considered the most sensitive sign of volume overload,although the commonly used‘method of Lewis’has several limitations.A useful cutoff is that if the JVP is greater than 3 cm in vertical distance above the sternal angle,the central venous pressure is elevated.In addition to assessment of volume status,the PE in HF can reveal adverse prognostic signs,namely:elevated JVP,presence of third heart sound,elevated heart rate,low systolic BP,and low proportional pulse pressure(＜25%).This article will review the evidence for the diagnostic and prognostic utility of common PE findings in HF.
