EM Cases · Paracentesis and thoracentesis
Cirrhotic with fever — diagnostic paracentesis for SBP
ACEM Fellowship procedure/clinical station on SBP paracentesis, SAAG, coagulopathy myths, and safe technique.
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Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
A man with known cirrhosis, tense ascites, fever and new confusion; INR 1.8, platelets 65.
Stem
All persons, presentations and observations in this station are fictional and invented for teaching assessment; they do not describe a real person.
References7ShowHide
- [1]Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept. Annals of Internal Medicine, 1992.PMID 1616215
- [4]Long B, Gottlieb M Emergency medicine updates: Spontaneous bacterial peritonitis. The American journal of emergency medicine, 2023.PMID 37244043
- [5]O'Leary JG, Greenberg CS, Patton HM, et al. AGA Clinical Practice Update: Coagulation in Cirrhosis. Gastroenterology, 2019.PMID 30986390
- [6]MacIntosh T Emergency Management of Spontaneous Bacterial Peritonitis - A Clinical Review. Cureus, 2018.PMID 29721399
- [7]Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. The New England journal of medicine, 1999.PMID 10432325
- [8]Bernardi M, Caraceni P, Navickis RJ, et al. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology (Baltimore, Md.), 2012.PMID 22095893
- [9]Torres E, Barros P, Calmet F Correlation between serum-ascites albumin concentration gradient and endoscopic parameters of portal hypertension. The American journal of gastroenterology, 1998.PMID 9820392