patient in Podcasts
personA patient with a history of myeloproliferative neoplasm and presenting with abdominal symptoms.
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As the workup became more and more complex, and we started to talk about doing repeat paracentesis to trend ascites fluid white blood cell counts, the patient was just exhausted.
So this brings into consideration entities like hepatic veno-occlusive disease, which can be seen in association with conditions such as myeloproliferative neoplasms, as is seen in this patient.
The next question which has been lingering on since the last aliquot is that does this patient actually have cirrhosis?
In this patient, the hepatic venous pressure gradient is only mildly elevated, and that is a critical pivot point in this case.
So I can pretty much understand why the transjugular approach was taken for this patient.
This route is particularly useful in patients with ascites or coagulopathy as it minimizes the bleeding risk by keeping any potential hemorrhage within the vascular system rather than in the peritoneal cavity.
This patient has risk factors for vaso-occlusive disease affecting the irrigation of his liver, and I wonder if we didn't have an infection on top, we would see Zach more compatible with non-cirrhotic portal hypertension.
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