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Peritoneovenous Shunt
A peritoneovenous shunt is a shunt which drains peritoneal fluid from the peritoneum into a large vein, usually the internal jugular vein. It is sometimes used in patients with refractory ascites. It is a long tube with a one-way valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which allows ascitic fluid to pass directly into the systemic circulation. Various models exist, among which the LeVeen shunt and the Denver shunt. Possible complications include: # Infection # Superior vena caval thrombosis # Pulmonary edema # Bleeding from varices # Disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking Microvessel, small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems ... References Implants (medicine) {{treatment-stub ...
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Shunt (medical)
In medicine, a shunt is a hole or a small passage that moves, or allows movement of, fluid from one part of the body to another. The term may describe either congenital or acquired shunts; acquired shunts (sometimes referred to as iatrogenic shunts) may be either biological or mechanical. __TOC__ Types * Cardiac shunts may be described as right-to-left, left-to-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemic. * Cerebral shunt: In cases of hydrocephalus and other conditions that cause chronic increased intracranial pressure, a one-way valve is used to drain excess cerebrospinal fluid from the brain and carry it to other parts of the body. This valve usually sits outside the skull but beneath the skin, somewhere behind the ear. Cerebral shunts that drain fluid to the peritoneal cavity (located in the upper abdomen) are called ''ventriculoperitoneal'' (''VP'') shunts. * Lumbar-peritoneal shunt (a.k.a. ''lumboperitoneal'', ''LP''): In cases ...
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Peritoneal Fluid
Peritoneal fluid is a serous fluid made by the peritoneum in the abdominal cavity which lubricates the surface of tissue that lines the abdominal wall and pelvic cavity. It covers most of the organs in the abdomen. An increased volume of peritoneal fluid is called ascites. Sampling of peritoneal fluid is generally performed by paracentesis. Peritoneal fluid analysis The serum-ascites albumin gradient (SAAG) is the most useful index for evaluating peritoneal fluid and can help distinguish ascites caused by portal hypertension (cirrhosis, portal vein thrombosis, Budd-Chiari syndrome, etc.) from other causes of ascites. SAAG is calculated by subtracting the albumin measure of ascitic fluid from the serum value. In portal hypertension, the SAAG is >1.1 g/dL while ascites from other causes shows a SAAG of less than 1.1 g/dL. Peritoneal fluid microscopy is a useful test in evaluating the cause of ascites. A diagnostic peritoneal lavage (DPL) is considered positive if any of the fol ...
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Peritoneum
The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesothelium supported by a thin layer of connective tissue. This peritoneal lining of the cavity supports many of the abdomen#Contents, abdominal organs and serves as a conduit for their blood vessels, lymphatic vessels, and nerves. The abdominal cavity (the space bounded by the vertebrae, abdominal muscles, Thoracic diaphragm, diaphragm, and pelvic floor) is different from the intraperitoneal space (located within the abdominal cavity but wrapped in peritoneum). The structures within the intraperitoneal space are called "intraperitoneal" (e.g., the stomach and intestines), the structures in the abdominal cavity that are located behind the intraperitoneal space are called "retroperitoneal" (e.g., the kidneys), and those structures below the intrape ...
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Vein
Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins. There are three sizes of veins: large, medium, and small. Smaller veins are called venules, and the smallest the post-capillary venules are microscopic that make up the veins of the microcirculation. Veins are often closer to the skin than arteries. Veins have less smooth muscle and connective tissue and wider internal diameters than arteries. Because of their thinner walls and wider lumens they are able to expand and hold more blood. This greater capacity gives them the term of ''capacitance vessels''. At any time, nearly 70% o ...
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Internal Jugular Vein
The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. It begins in the posterior compartment of the jugular foramen, at the base of the skull. It is somewhat dilated at its origin, which is called the ''superior bulb''. This vein also has a common trunk into which drains the anterior branch of the retromandibular vein, the facial vein, and the lingual vein. It runs down the side of the neck in a vertical direction, being at one end lateral to the internal carotid artery, and then lateral to the common carotid artery, and at the root of the neck, it unites with the subclavian vein to form the brachiocephalic vein (innominate vein); a little above its termination is a second dilation, the ''inferior bulb''. Above, it lies upon the rectus capitis lateralis, behind the internal carotid artery and the nerves pa ...
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Ascites
Ascites (; , meaning "bag" or "sac") is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Complications can include spontaneous bacterial peritonitis. In the developed world, the most common cause is liver cirrhosis. Other causes include cancer, heart failure, tuberculosis, pancreatitis, and blockage of the hepatic vein. In cirrhosis, the underlying mechanism involves high blood pressure in the portal system and dysfunction of blood vessels. Diagnosis is typically based on an examination together with ultrasound or a CT scan. Testing the fluid can help in determining the underlying cause. Treatment often involves a low-salt diet, medication such as diuretics, and draining the fluid. A transjugular intrahepatic portosystemic shunt (TIPS) may be ...
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Pulmonary Edema
Pulmonary edema (British English: oedema), also known as pulmonary congestion, is excessive fluid accumulation in the tissue or air spaces (usually alveoli) of the lungs. This leads to impaired gas exchange, most often leading to shortness of breath ( dyspnea) which can progress to hypoxemia and respiratory failure. Pulmonary edema has multiple causes and is traditionally classified as cardiogenic (caused by the heart) or noncardiogenic (all other types not caused by the heart). Various laboratory tests ( CBC, troponin, BNP, etc.) and imaging studies (chest x-ray, CT scan, ultrasound) are often used to diagnose and classify the cause of pulmonary edema. Treatment is focused on three aspects: * improving respiratory function, * treating the underlying cause, and * preventing further damage and allow full recovery to the lung. Pulmonary edema can cause permanent organ damage, and when sudden (acute), can lead to respiratory failure or cardiac arrest due to hypoxia ...
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Disseminated Intravascular Coagulation
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking Microvessel, small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts of the body. As clotting factors and platelets are used up, bleeding may occur. This may include hematuria, blood in the urine, GI bleed, blood in the stool, or bleeding into the skin. Complications may include organ failure. Relatively common causes include sepsis, surgery, major trauma, cancer, and complications of pregnancy. Less common causes include snake bites, frostbite, and burns. There are two main types: acute (rapid onset) and chronic (slow onset). Diagnosis is typically based on blood tests. Findings may include thrombocytopenia, low platelets, low fibrinogen, high International normalized ratio, INR, or high D-dimer. Treatment is mainly directed towards the underlying condition. Other measures may include givin ...
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