Abdominal free fluid

Overall, increased gallbladder volume, abdominal free fluid and mesenteric lymph node enlargement reliably and accuratelypredict CD, whereas the lack of intestinal dilatation and increased peristalsis makes it possible to rule out the diagnosis. The specificity of US was 99% in the presence of all six signs, with an obvious decrease in sensitivity (33%) moreover, an LR+ value of 50 allowed a confirmatory strategy and... 

Fig. 9.2a,b. Ultrasound images show a small amount of anechoic free fluid (/) within the abdominal cavity in coeliac disease. Free fluid (white arrow), bowel loop (black arrow)... 

Greco, A. V., Mingrone, G., Gasbarrini, G. Clin. Chim. Acta 239, 1995, 13-22. Free fatty acid analysis in ascitic fluid improves diagnosis in malignant abdominal tumors. 

Use of lacmlose can cause cramps and abdominal discomfort. High doses may produce excessive loss of fluid and K+. Lactulose is contraindicated in patients on a galactose-free diet and in patients with diabetes. 

Osmotic laxatives (e.g., lactulose, sorbitol) are poorly absorbed or nonabsorbable compounds that draw additional fluid into the GI tract. Lumen osmolality increases, and fluid movement occurs secondary to osmotic pressure. Lactulose is a synthetic disaccharide that is poorly absorbed from the GI tract, since no mammalian enzyme is capable of hydrolyzing it to its monosaccharide components. It therefore reaches the colon unchanged and is metabolized by colonic bacteria to lactic acid and to small quantities of formic and acetic acids. Since lactulose does contain galactose, it is contraindicated in patients who require a galactose-free diet. Metabolism of lactulose by intestinal bacteria may result in increased formation of intraluminal gas and abdominal distention. Lactulose is also used in the treatment of hepatic encephalopathy. 

In 1959 a very reliable physical sign was described which is present consistently with as little as 120 ml of peritoneal fluid ( puddle sign )- This phenomenon also makes it possible to differentiate shifting dullness due to fluid-filled loops of bowel from that due to collections of free intra-abdominal fluid. The puddle sign is generally not influenced by obesity. (46)... 

Abdominal X-ray will reveal free intraperitoneal air on upright or decubitus films (Fig. 3.12), no gastric air-fluid level can be demonstrated. 

In a case-control study of 11 adults with histologically proven CD and 20 healthy subjects (Table 9.2), Rettenbacher et al. (1999) found that the controls were negative, whereas the cases showed an increase in intraluminal fluid content, the presence of moderate small bowel dilatation, increased peristalsis and moderate bowel wall thickness. Further extra-intestinal signs, such as mesenteric lymph node enlargement, free abdominal fluid, a dilated superior mesenteric artery or portal vein, and hepatic steatosis, were also identified with overall frequencies of 52-84% (Rettenbacher et al. 1999). 

Interestingly, the positive likelihood ratios (LR-t) of >10 observed for increased gallbladder volume, free abdominal fluid and enlarged mesenteric lymph nodes allowed a confirmatory strategy, whereas the negative likelihood ratios (LR-) of 0.1 observed for dilated small bowel loops and increased peristalsis supported an exclusion strategy (Sackett and Haynes 2002). 

Ascites Accumulation of free serous fluid in the abdominal cavity. 

Fig. 12.6a-e. Perforation of peptic ulcer. Contrast enhanced CT (CECT) images in five different cases demonstrating a free air anterior to the stomach and free air and fluid in the lesser sac due to perforation of posterior gastric wall ulcer b free intraabdominal air and fluid due to perforation of anterior duodenal bulb ulcer c free air due to duodenal ulcer perforation (arrow) d free air extending into the anterior abdominal wall due to perforation of a duodenal ulcer e retroperitoneal abscess complicating perforation of a posterior duodenal ulcer... 

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