53.2 📚 國考版醫垫國考 / PGY OSCE

53.2.0.1 📌 Cram Sheet

53.2.0.1.1 🔥 高 yield 8
  1. 6F for distension
  2. Cirrhosis 80% of ascites
  3. SAAG ≥ 1.1 = portal HTN
  4. SAAG < 1.1 = non-portal (malignancy, TB, nephrotic)
  5. SBP = ANC ≥ 250 → ceftriaxone + albumin
  6. Albumin reduces HRS / mortality in SBP
  7. Spironolactone:furosemide 2.5:1
  8. Refractory ascites → LVP + alb → TIPS → transplant
53.2.0.1.2 🔢 必背
項目 æ•žå­—
SAAG portal ≥ 1.1
SBP ANC ≥ 250
Albumin SBP day 1 1.5 g/kg
Albumin SBP day 3 1 g/kg
LVP albumin 8 g/L removed (> 5 L)
Spironolactone:furosemide 100:40 (2.5:1)
Salt restriction < 2 g/d
Cardiac ascites total protein > 2.5

53.2.0.2 ⭐ 高 yield

53.2.0.2.1 SAAG Categories
SAAG ≥ 1.1 SAAG < 1.1
Cirrhosis Peritoneal carcinomatosis
HF TB peritonitis
Budd-Chiari Pancreatic
Massive liver mets Nephrotic
Constrictive pericarditis Biliary
53.2.0.2.2 Cardiac vs Cirrhotic Ascites
  • Both SAAG ≥ 1.1
  • Cardiac total protein > 2.5
  • Cirrhotic total protein < 2.5
53.2.0.2.3 SBP Treatment
  • Ceftriaxone 2 g/d × 5-7 d
  • Albumin 1.5 g/kg day 1, 1 g/kg day 3
  • Cefepime / pip-tazo if hospital-acquired
  • Repeat para to confirm response
53.2.0.2.4 Refractory Ascites
  • Diuretic-resistant or diuretic-intractable
  • LVP + albumin
  • TIPS for selected (Child A-B, no encephalopathy)
  • Liver transplant evaluation
53.2.0.2.5 TB Peritonitis
  • AFB low yield, ADA elevated
  • Lymphocyte-predominant
  • Treat with anti-TB
53.2.0.2.6 Malignant Ascites
  • Cytology + (multiple paras improve yield)
  • Peritoneal carcinomatosis
  • Treat malignancy + paracentesis + intraperitoneal chemotherapy

53.2.0.3 🎯 自我檢枬

  1. SAAG ≥ 1.1? → Portal HTN
  2. SBP ANC threshold? → ≥ 250
  3. SBP treatment? → Ceftriaxone + albumin
  4. Cardiac vs cirrhotic SAAG? → Both ≥ 1.1, total protein 區分
  5. LVP albumin? → 8 g/L removed
  6. Spironolactone:furosemide? → 2.5:1
  7. TIPS contraindication? → Severe encephalopathy

⚠ AI 草皿。