When these indicators are abnormal in patients with abdominal effusion, referrals should be made quickly!

It is only for reference by medical professionals.
What should we do when we encounter patients with abdominal effusion in clinical practice? Recently, I took over a case of abdominal effusion, admitted to the gastroenterology department with abdominal distension, but finally transferred to the gynecology department to understand this tortuous story
.

Case review: Unexplained abdominal effusion! Aunt Huang, 60 years old this year, is in good health and is at the age of eating Ma Ma Xiang.
More than 10 days ago, she suddenly experienced abdominal distension, abdominal pain, accompanied by anorexia, constipation, no nausea, vomiting, acid reflux, heartburn and other discomforts, and poor diet.
Hepatobiliary, pancreatic and spleen color Doppler ultrasound examination showed no abnormalities, and oral medications had no obvious effect
.

The symptoms of abdominal distension and abdominal pain are getting worse.
In order to confirm the diagnosis, I came to our outpatient clinic and performed abdominal CT examination which showed fluid in the abdominal cavity.
Therefore, the department of gastroenterology was admitted to the Department of Gastroenterology with "Ascites fluid"
.

Past history: history of breast fibroadenoma surgery, regular review after surgery without discomfort
.

He has a history of hypothyroidism for 20 years, and he has been taking Oral for a long time
.

Regular monitoring of thyroid function is normal
.

Admission examination: clear mind, low spirits, clear breath sounds in both lungs, no dry and wet rales, uniform heart rhythm, no pathological murmurs in the auscultation area of ​​the heart valves, soft abdomen, bulging, upper abdominal tenderness, none Rebound pain, unsatisfactory palpation of liver and spleen, positive mobile dullness, normal bowel sounds, and no edema in both lower limbs
.

Auxiliary examination: (2021-10-16, our hospital) Abdominal CT examination: 1.
A large amount of abdominal and pelvic effusion with diffuse thickening of the greater omentum; 2.
Gallbladder stones, accessory spleen
.

(2021-10-13, our hospital) Hepatobiliary, pancreatic and spleen color Doppler ultrasound examination: moderate fatty liver, gallbladder stones
.

Initial diagnosis: 1.
Abdominal effusion; 2.
Pelvic effusion; 3.
Gallbladder stones; 4.
Hypothyroidism
.

Etiological investigation: The test indicators showed that CA125 was elevated.
After admission, Aunt Huang immediately improved blood routine, coagulation, liver function, renal function, electrolytes, tumor markers and other related tests.
The results of the following figure indicate that CA125 is high, and the rest have no obvious abnormalities
.

(Note CA125: It is a macromolecular glycoprotein surface antigen derived from body cavity epithelial cells, mainly distributed in mesothelial cells and Mullerian ducts in the pleura, peritoneum, pericardium, etc.
, and also in ovarian epithelial cells and reproductive tract epithelial cells Surface
.

CA125 is currently the most commonly used marker for the diagnosis of ovarian cancer
.

But in some gynecological benign diseases such as endometriosis, pelvic inflammatory diseases, patients with different degrees of increase
.

) Physician thinking: the next step, what to do? Improve the enhanced CT examination of the abdomen, or should you take the ascites first? Common causes of abdominal distension include intestinal obstruction, chronic pancreatitis, gastrointestinal mass, and pelvic mass
.

The patient's abdominal distension and peritoneal effusion, first consider liver cirrhosis and peritoneal effusion
.

Repeated contact with imaging physicians and reading the film many times, no obvious signs of space-occupying lesions and liver cirrhosis were seen, and the enhanced CT examination of the entire abdomen was expensive, and the problem might not be found
.

Communicating with family members many times, this route will not be considered for the time being
.

Pump the water for testing, this is an invasive operation
.

Repeated communication with the patient and family members, the family members did not accept at first, and after repeated communication with the doctors, the family members finally agreed to perform abdominal puncture and ascites discharge
.

On the morning of October 17, 2021, abdominal puncture and ascites were performed
.

Improve ascites routine, biochemical, tumor markers, exfoliated cytology and other related examinations
.

The biochemistry of ascites was normal
.

Routine examinations of ascites are as follows: Ascites tumor markers: blood CA125 and ascites CA125 are high, perfect gynecological color Doppler ultrasound examination is as follows: from the gynecological color Doppler ultrasound, no major problems can be seen
.

Is there any disease that we missed that we don't know? After consultation with a specialist doctor, it is finally determined that the cause, combined with the patient’s symptoms and related laboratory tests, still suggest that there is a high possibility of gynecological tumors, so please consult a professional gynecologist
.

Real experts know if there is any
.

The gynecologist gently touched his hands and performed a gynecological examination.
He considered normal-sized ovarian cancer syndrome and recommended that he be transferred to the department for treatment
.

After communicating with family members, he was transferred to the gynecology department for further treatment
.

The pathological report of ascites after entering the department of gynecology is as follows: immunohistochemistry: perfecting human epididymal secretory protein after entering the specialty department: getting better and discharged after chemotherapy, and the diagnosis is normal-sized ovarian cancer syndrome
.

Doubt resolution: What is the normal size ovarian cancer syndrome? There are really not many clinically encountered
.

Normal-size ovarian cancer syndrome is a clinical phenomenon in which diffuse pelvic and abdominal cavity cancers are extensive, and the bilateral ovaries are of normal size and (or) there are small nodules on the surface of the ovaries
.

Normal-size ovarian cancer syndrome has hidden clinical symptoms, difficult early diagnosis, high misdiagnosis rate, and most of it is late when found, and it is one of the tumors with higher mortality in female reproductive system tumors
.

It includes four types of tumors: primary ovarian cancer, extragonadal Mullerian tumors that are extraovarian peritoneal serous papillary cystadenocarcinoma, metastatic tumors of unknown organs, and peritoneal malignant stromal tumors
.

Most scholars believe that the prognosis of normal-sized ovarian cancer syndrome is worse than that of ovarian cancer.
This is mainly due to the fact that the bilateral ovaries of the woman are normal in size at the time of examination.
Doctors cannot easily think of the disease.
When the patient develops symptoms, the pelvis and abdominal cavity are full.
Lesions
.

Treatment: Thorough tumor reduction surgery and timely, effective, and adequate chemotherapy after surgery can significantly prolong the average survival time of patients and increase the survival probability
.

Summary of experience: Unexplained cause of abdominal effusion: We should do this
.

When clinically encountering an unexplained abdominal effusion, 1, try to send biochemical, routine, pathological examinations, and perfect imaging examinations
.

Understand whether it is leakage or exudate
.

2.
Once you find that if your major cannot solve it, you must actively seek help and guidance from the brother's department
.

3.
Not all peritoneal effusions are diseases of gastroenterology
.

This requires us to keep learning in the process of clinical practice, not only specialized, but also extensive
.

References: [1] Hu Xiangdan, Xiao Jing, Changes in serum HE4 and CA125 levels in patients with ovarian cancer.
Article number: 1002-266X (2017) 12-0058-03.
[2] Yue Juan, Liu Fei, Early diagnosis of ovarian cancer Research progress of serum tumor markers, International Journal of Obstetrics and Gynecology, 2015, 42(5); 560-563.
[3] Hao Yuzhi, Huang Suli, Niu Lijuan and others.
Ultrasound diagnosis of ovarian metastases.
Chinese Medical Imaging Technology.
2002, 18(4):358
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359.