Study group discussion: A question on ascites

Source:  Study group discussion: A question on ascites    Tag:  what is coxsackie b virus

Here's a exam oriented question I made up:

28 year old male presents with abdominal distension. Temp 37, pulse 92, BP 110/70, RR 18. On examination you find that he has hepatomegaly, ascites and his jvp is 8 cm above the sternal angle. Urinalysis is normal. He has history of alcohol abuse, had a viral infection few weeks back.

What is the cause of his ascites?
Urinary protein loss
Malnutrition
Liver disease
Portal vein compression
Thrombosis of hepatic vein
Pericarditis
Nephrotic syndrome

Discussion:

Liver disease?

Umm it's not liver disease. He would have symptoms of jaundice if he had liver disease.

Ohh, I thought hepatitis virus.

Pericarditis! The jvp and viral infection is the catch here.

Yes!

Nice question.. Hungry for more!

I almost thought it was viral hepatitis then I remembered that viral hepatitis shrinks the liver...Good question ..moore.

But what's the connection between pericarditis and the ascites!? Someone explain please!

Blood can't fill in the heart adequately during diastole, which causes an elevated venous pressure. It results in JVP, ascites etc

What's the answer to the case IkaN?

It's pericarditis.

Anyone wants to guess the etiology? Like what caused the pericarditis?

Alcohol abuse? Immunosuppression?

The alcohol abuse was intended to be a huge distractor. The guy simply had viral pericarditis due to Coxsackie B virus.

You have to assume Coxsackie because it's the most common cause of viral pericarditis.

I read somewhere that people who binge drink a lot are at risk of getting bacterial pericarditis..Streptococcus or Staphylococcus type..I didnt know about viral...It makes a lot sense though..Epidemiology rarely lies.

Oh I didn't know this. I know that alcoholics are predisposed to spontaneous bacterial peritonitis.

Yah its due to low immunity..another risk is in patients who have undergone pericardiocentesis.

Yes.

What is the mechanism of pericarditis?

Pericarditis is when there is inflammation of the pericardial sac. One of the many uses of pericardial sac is to reduce the friction over the heart with every heartbeat. There also can be collection of fluid in the pericardial sac.

It can be acute or chronic, and is usually classified by what the pericardiac fluid contains.