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It is only for medical professionals to read for reference.
A middle-aged woman was admitted to the ward.
Suddenly there was a lot of ascites, and her abdominal distension was like a drum.
.
.
What is the reason? See how the clinician peels the silk and draws the cocoon, cracks layer by layer, looking for the "true murderer".
This is the second time she has been admitted to our department.
The last time she was hospitalized was also due to a sudden large amount of ascites.
The doctor in charge did her best to do a lot of examinations.
The hepatitis series and liver function tests were all normal.
The common causes of ascites, such as portal hypertension, tuberculosis infection, and heart disease, were uniform.
Once ruled out, the real cause of ascites has never been found.
After diuretic treatment, the patient's ascites was slowly eliminated and discharged.
Figure 1 A CT picture of the patient’s abdomen.
A plain CT scan of the abdomen showed a large amount of fluid and ascites in the abdomen and pelvis.
What was the cause of the patient’s re-admission to the hospital? It seems to be another challenging case.
I carefully reviewed all the test results of her two hospitalizations, and found that there were manifestations of renal insufficiency in each hospitalization, and the values of urea nitrogen and creatinine in the two renal function tests were significantly increased.
Is she ascites caused by kidney disease? However, her urine test was normal, there was no urine protein, and the liver function test showed that the serum albumin value did not decrease, which did not meet the ascites caused by hypoproteinemia caused by kidney disease.
Moreover, her two episodes of ascites occurred suddenly, which did not meet the characteristics of hypoproteinemia.
Is it the obstruction of the large blood vessels in the abdominal cavity, causing ascites caused by increased blood vessel pressure? However, the patient did not have abdominal pain.
Both the last hospitalization and this hospitalization performed intensive CT examinations of the chest and abdomen, and no thrombosis or embolism in the abdominal or pelvic blood vessels was found.
Figure 2 Is the patient's biochemical results ascites caused by abdominal tumors or gynecological tumors? The patient underwent a gastrointestinal endoscopy during the last hospitalization.
No signs of tumors were found.
CT scans of the chest and abdomen showed no signs of other tumors.
Both ascites tests were leaked fluid, and no tumor cells were found in the ascites. The patient had cervical cancer 10 years ago and had undergone radiotherapy.
However, in recent years, there have been no obvious problems in gynecological examinations.
Figure 3 The results of routine examination of the patient’s ascites solved the mystery.
From the time when I asked about the medical history carefully, I asked about the medical history again.
I learned that the patient had a large amount of ascites after urinating twice.
He had slight abdominal pain during urination, and he soon improved on its own.
After ascites, the patient's urine output was significantly reduced.
Ascites appear after urination.
Is it because the urine leaked into the abdominal cavity? However, this patient was not traumatized before the onset of the disease, how could he have a bladder rupture? Why does the patient not have persistent abdominal pain? How can the impairment of kidney function be explained? In any case, even if there are many doubts, this patient has two ascites after urination, and this diagnosis still needs to be ruled out.
I hurriedly consulted the director of the laboratory department and asked him how he could verify whether there was water or urine in the abdominal cavity.
The director of the laboratory told me that it can be judged by testing the urea nitrogen and creatinine values in the ascites.
If urine leaks into the abdominal cavity, the urea nitrogen and creatinine values in the ascites will increase significantly.
Generally speaking, the ratio of ascites creatinine/plasma creatinine is 1:1.
If the ratio of ascites creatinine/plasma creatinine is 3:1 or more, it often indicates the possibility of urinary ascites.
Figure 4 The mystery of the patient's ascites creatinine test results is gradually solved.
It turned out that it leaked into the abdominal cavity, so we urgently performed an ascites puncture and sent it to the laboratory.
The test results indicated that the ascites urea nitrogen was 28.
68mmol/L and the creatinine was 902μmol/L.
The ratio of ascites creatinine to plasma creatinine is 3.
68:1.
It seems that urine leaked into the abdominal cavity! We further performed a bladder perfusion test to verify whether there is a bladder fistula.
After instructing the patient to empty the bladder, he infused 350ml of saline into the patient's bladder through a catheter, and only 200ml of urine was discharged after 1 hour, which indicates that there is indeed a leak in the bladder.
The cystourerography examination confirmed a small breach in the right wall of the patient's bladder.
Figure 5 A picture of the patient’s cystography.
The cystography showed that the bladder was not well filled, and part of the contrast agent diffused into the pelvis.
The right side is the original.
This patient developed radiation cystitis after radiotherapy for cervical cancer and has been treated with traditional Chinese medicine many times.
.
Long-term radiation cystitis leads to fibrosis of the bladder mucosa and weakening of the bladder wall tension, so a small tear appears after the patient urinates violently, causing urine to leak into the abdominal cavity, forming urinary ascites.
Urinary ascites is a rare cause of ascites.
Urinary ascites is generally caused by pathological changes of the bladder and obstruction of the outflow tract.
After the urine leaks into the abdominal cavity, due to the high osmotic pressure of the urine, the water continuously enters the abdominal cavity and produces a lot of ascites.
The creatinine and urea nitrogen in the urine use the peritoneum as a semipermeable membrane to perform "peritoneal dialysis" by itself through diffusion, which in turn increases the blood creatinine, leading to the performance of pseudo-renal failure.
The cause is clear, and the treatment will naturally be targeted.
We placed a urinary catheter for the patient, the decrease in urine volume disappeared, and the renal function test returned to normal.
After diuretic treatment, ascites is also quickly eliminated.
The patient was transferred to the Department of Urology for cystoscopy and repair surgery, and there was no urinary ascites after the operation.
Reference: [1] Zhou C, Ying X, Feng W.
Pseudo-acute Renal Failure due to Intraperitoneal Urine Leakage.
Intern Med.
2015,54(14):1777-1780.
[2]Oey RC,van Buuren HR, de Man RA.
The diagnostic work-up in patients with ascites:current guidelines and future prospects.
Neth J Med.
2016;74(8):330-335.
[3]Jin Haifeng, Chen Ying.
Urinary ascites with acute 1 case of renal failure.
Shandong Medicine, 2010, 50(44): 46.
A middle-aged woman was admitted to the ward.
Suddenly there was a lot of ascites, and her abdominal distension was like a drum.
.
.
What is the reason? See how the clinician peels the silk and draws the cocoon, cracks layer by layer, looking for the "true murderer".
This is the second time she has been admitted to our department.
The last time she was hospitalized was also due to a sudden large amount of ascites.
The doctor in charge did her best to do a lot of examinations.
The hepatitis series and liver function tests were all normal.
The common causes of ascites, such as portal hypertension, tuberculosis infection, and heart disease, were uniform.
Once ruled out, the real cause of ascites has never been found.
After diuretic treatment, the patient's ascites was slowly eliminated and discharged.
Figure 1 A CT picture of the patient’s abdomen.
A plain CT scan of the abdomen showed a large amount of fluid and ascites in the abdomen and pelvis.
What was the cause of the patient’s re-admission to the hospital? It seems to be another challenging case.
I carefully reviewed all the test results of her two hospitalizations, and found that there were manifestations of renal insufficiency in each hospitalization, and the values of urea nitrogen and creatinine in the two renal function tests were significantly increased.
Is she ascites caused by kidney disease? However, her urine test was normal, there was no urine protein, and the liver function test showed that the serum albumin value did not decrease, which did not meet the ascites caused by hypoproteinemia caused by kidney disease.
Moreover, her two episodes of ascites occurred suddenly, which did not meet the characteristics of hypoproteinemia.
Is it the obstruction of the large blood vessels in the abdominal cavity, causing ascites caused by increased blood vessel pressure? However, the patient did not have abdominal pain.
Both the last hospitalization and this hospitalization performed intensive CT examinations of the chest and abdomen, and no thrombosis or embolism in the abdominal or pelvic blood vessels was found.
Figure 2 Is the patient's biochemical results ascites caused by abdominal tumors or gynecological tumors? The patient underwent a gastrointestinal endoscopy during the last hospitalization.
No signs of tumors were found.
CT scans of the chest and abdomen showed no signs of other tumors.
Both ascites tests were leaked fluid, and no tumor cells were found in the ascites. The patient had cervical cancer 10 years ago and had undergone radiotherapy.
However, in recent years, there have been no obvious problems in gynecological examinations.
Figure 3 The results of routine examination of the patient’s ascites solved the mystery.
From the time when I asked about the medical history carefully, I asked about the medical history again.
I learned that the patient had a large amount of ascites after urinating twice.
He had slight abdominal pain during urination, and he soon improved on its own.
After ascites, the patient's urine output was significantly reduced.
Ascites appear after urination.
Is it because the urine leaked into the abdominal cavity? However, this patient was not traumatized before the onset of the disease, how could he have a bladder rupture? Why does the patient not have persistent abdominal pain? How can the impairment of kidney function be explained? In any case, even if there are many doubts, this patient has two ascites after urination, and this diagnosis still needs to be ruled out.
I hurriedly consulted the director of the laboratory department and asked him how he could verify whether there was water or urine in the abdominal cavity.
The director of the laboratory told me that it can be judged by testing the urea nitrogen and creatinine values in the ascites.
If urine leaks into the abdominal cavity, the urea nitrogen and creatinine values in the ascites will increase significantly.
Generally speaking, the ratio of ascites creatinine/plasma creatinine is 1:1.
If the ratio of ascites creatinine/plasma creatinine is 3:1 or more, it often indicates the possibility of urinary ascites.
Figure 4 The mystery of the patient's ascites creatinine test results is gradually solved.
It turned out that it leaked into the abdominal cavity, so we urgently performed an ascites puncture and sent it to the laboratory.
The test results indicated that the ascites urea nitrogen was 28.
68mmol/L and the creatinine was 902μmol/L.
The ratio of ascites creatinine to plasma creatinine is 3.
68:1.
It seems that urine leaked into the abdominal cavity! We further performed a bladder perfusion test to verify whether there is a bladder fistula.
After instructing the patient to empty the bladder, he infused 350ml of saline into the patient's bladder through a catheter, and only 200ml of urine was discharged after 1 hour, which indicates that there is indeed a leak in the bladder.
The cystourerography examination confirmed a small breach in the right wall of the patient's bladder.
Figure 5 A picture of the patient’s cystography.
The cystography showed that the bladder was not well filled, and part of the contrast agent diffused into the pelvis.
The right side is the original.
This patient developed radiation cystitis after radiotherapy for cervical cancer and has been treated with traditional Chinese medicine many times.
.
Long-term radiation cystitis leads to fibrosis of the bladder mucosa and weakening of the bladder wall tension, so a small tear appears after the patient urinates violently, causing urine to leak into the abdominal cavity, forming urinary ascites.
Urinary ascites is a rare cause of ascites.
Urinary ascites is generally caused by pathological changes of the bladder and obstruction of the outflow tract.
After the urine leaks into the abdominal cavity, due to the high osmotic pressure of the urine, the water continuously enters the abdominal cavity and produces a lot of ascites.
The creatinine and urea nitrogen in the urine use the peritoneum as a semipermeable membrane to perform "peritoneal dialysis" by itself through diffusion, which in turn increases the blood creatinine, leading to the performance of pseudo-renal failure.
The cause is clear, and the treatment will naturally be targeted.
We placed a urinary catheter for the patient, the decrease in urine volume disappeared, and the renal function test returned to normal.
After diuretic treatment, ascites is also quickly eliminated.
The patient was transferred to the Department of Urology for cystoscopy and repair surgery, and there was no urinary ascites after the operation.
Reference: [1] Zhou C, Ying X, Feng W.
Pseudo-acute Renal Failure due to Intraperitoneal Urine Leakage.
Intern Med.
2015,54(14):1777-1780.
[2]Oey RC,van Buuren HR, de Man RA.
The diagnostic work-up in patients with ascites:current guidelines and future prospects.
Neth J Med.
2016;74(8):330-335.
[3]Jin Haifeng, Chen Ying.
Urinary ascites with acute 1 case of renal failure.
Shandong Medicine, 2010, 50(44): 46.
