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A 63-year-old woman with new-onset ascites

63 years old | Female

Vignette:

A 63-year-old woman is admitted to the hospital with new-onset ascites. She has a history of long-standing diabetes and hypertension. She has never formally been given a diagnosis of liver disease. Despite increasing abdominal distension, she has lost 13.5 kg in the last year. Physical exam reveals a lethargic-appearing woman with temporal wasting, massive ascites, and 2+ pitting edema. She has numerous spider nevi over her chest wall and marked palmar erythema.

Summary:

new-onset | ascites | diabetes | hypertension | abdominal distension | weight loss | lethargic | temporal wasting | pitting edema | spider nevi over chest | palmar erythema

Dx:

Non-Alcoholic Fatty Liver Disease Hepatic steatosis

Ref:

https://online.epocrates.com/diseases/79622/Hepatic-steatosis/Common-Vignette

Rank

Disease

Weight

1 Primary sclerosing cholangitis 481.0
2 Biliary cirrhosis 481.0
3 Primary biliary cirrhosis 461.0
4 Liver Cirrhosis 456.0
5 Hepatocellular carcinoma 409.0
6 Hepatic Encephalopathy 404.0
7 Tuberculous Peritonitis 400.0
8 Hereditary hemochromatosis 389.0
9 Non-alcoholic Fatty Liver Disease 351.0
10 Chronic heart failure 348.0
11 Amebic Liver Abscess 329.0
12 Mesenteric ischemia 329.0
13 Hepatorenal Syndrome 328.0
14 Alcoholic Fatty Liver 326.0
15 Alcoholic hepatitis 320.0
16 Chronic Kidney Diseases 320.0
17 Aortic Dissection 320.0
18 Klebsiella pneumoniae liver abscess 308.0
19 Alcoholic Liver Cirrhosis 301.0
20 Acute Cholecystitis 298.0
21 Alcoholic Liver Disease 296.0
22 Pyogenic Liver Abscess 289.0
23 Gastroparesis 287.0
24 Diabetic Amyotrophy 287.0
25 Brucellosis 283.0
26 pancreatic cancer 279.0
27 Eclampsia 271.0
28 Stable ischemic heart disease 271.0
29 Cushing syndrome 270.0
30 Emphysematous cholecystitis 262.0
31 Kidney stones 260.0
32 Cystic Fibrosis 260.0
33 Graves Disease 260.0
34 Polyarteritis nodosa 259.0
35 Diabetic Neuropathy 258.0
36 Acute bacterial meningitis in adults 258.0
37 Type 2 Diabetes mellitus 255.0
38 Stroke 255.0
39 Intra-abdominal abscess 248.0
40 Salmonella infection 248.0
41 Ischemic stroke 242.0
42 Chronic atrial fibrillation 241.0
43 Analgesic nephropathy 240.0
44 Liver Abscess 235.0
45 Sarcoidosis 235.0
46 Chronic Hepatitis 234.0
47 Colorectal cancer 231.0
48 Celiac Disease 231.0
49 Spontaneous bacterial peritonitis 228.0
50 Ruptured ectopic pregnancy 228.0
51 Renal and perinephric abscess 225.0
52 Henoch-Schonlein purpura 225.0
53 Autosomal Recessive Polycystic Kidney Disease 224.0
54 Acute intermittent porphyria 223.0
55 Intussusception 221.0
56 Endometrial cancer 221.0
57 Adrenocortical carcinoma 220.0
58 Chronic Pancreatitis 219.0
59 Intestinal Obstruction 217.0
60 Transient ischemic attack 217.0
61 Autoimmune hepatitis 210.0
62 Non-ST-elevation myocardial infarction 209.0
63 Ankylosing spondylitis 209.0
64 Ischemic optic neuropathy 206.0
65 posteriorischemic optic neuropathy 206.0
66 Hereditary Angioedema 205.0
67 Crohn Disease 204.0
68 Ovarian Cancer 202.0
69 Preeclampsia 201.0
70 Rheumatoid Arthritis 200.0
71 Addison Disease 199.0
72 Liver disease 198.0
73 Ovarian and fallopian tube torsion 197.0
74 Bacterial pharyngitis 197.0
75 Chronic liver disease 196.0
76 anterior ischemic optic neuropathy 196.0
77 Pneumonia 195.0
78 Cholangiocarcinoma 194.0
79 COPD Exacerbation 193.0
80 Glomerulonephritis 191.0
81 Prinzmetal angina 190.0
82 Deep venous thrombosis 190.0
83 Psoas Abscess 189.0
84 Osteoporosis 189.0
85 Non-diabetic hypoglycemia 188.0
86 Choledocholithiasis 187.0
87 Gastric Outlet Obstruction 185.0
88 Renal Artery Stenosis 185.0
89 Giardiasis 185.0
90 Hyperaldosteronism 185.0
91 Bell palsy 184.0
92 Acute Liver Failure 182.0
93 Systemic lupus erythematosus 180.0
94 Alzheimer disease 180.0
95 Cataract 175.0
96 Food poisoning 173.0
97 Gallbladder cancer 170.0
98 Anaphylaxis 170.0
99 Acute bacterial meningitis in neonates 168.0
100 Hemolytic uremic syndrome 167.0
101 Granulomatosis with polyangiitis 167.0
102 Obstructive Sleep Apnea 166.0
103 Type 1 Diabetes mellitus 166.0
104 Hemorrhagic stroke 164.0
105 Urinary Tract Obstruction 163.0
106 Guillain-Barre syndrome 163.0
107 Hypertriglyceridemia 163.0
108 Acute pyelonephritis in adults 162.0
109 Budd Chiari Syndrome 161.0
110 Short bowel syndrome 161.0
111 Aortic coarctation 160.0
112 Primary Myelofibrosis 159.0
113 Insomnia in adults 159.0
114 Acromegaly 156.0
115 Systemic sclerosis 155.0
116 Gout 154.0
117 Painless thyroiditis 154.0
118 Renal Cell Carcinoma 153.0
119 Cryptococcosis 153.0
120 Hyperosmolar Hyperglycemic state 153.0
121 Hyperparathyroidism 152.0
122 Esophagitis 151.0
123 Central retinal artery occlusion 150.0
124 Cellulitis 150.0
125 Wilson disease 149.0
126 Ovarian Hyperstimulation Syndrome 148.0
127 Premenstrual syndrome 148.0
128 Diabetic Ketoacidosis 146.0
129 Hyperprolactinemia 145.0
130 Diabetes Mellitus 144.0
131 Gingivitis 143.0
132 Balanitis 142.0
133 Carpal Tunnel Syndrome 141.0
134 Dyspepsia 140.0
135 Ulcerative Colitis 137.0
136 Acute Myeloid Leukemia in adults 137.0
137 Graves ophthalmopathy 136.0
138 Oral candidiasis 135.0
139 Toxic Megacolon 135.0
140 Gallstones 133.0
141 Ascites 132.0
142 Abdominal compartment syndrome 130.0
143 Autoimmune Pancreatitis 129.0
144 Hyperthyroidism 129.0
145 Open Angle Glaucoma 129.0
146 Peyronie Disease 129.0
147 Dry eye 129.0
148 Secondary hypogonadism 129.0
149 Labyrinthitis 129.0
150 Achilles tendinopathy 129.0
151 Achilles tendon rupture 129.0
152 Acute bacterial meningitis in children 128.0
153 Gastric cancer 126.0
154 Clostridium difficile infection 126.0
155 Amyloidosis 126.0
156 Amphetamine use disorder 125.0
157 Sigmoid volvulus 125.0
158 Peutz-Jeghers Syndrome 124.0
159 Erectile dysfunction 124.0
160 Muscle Layer Eosinophilic gastroenteritis 123.0
161 End Stage Renal Disease 123.0
162 Leiomyomas 121.0
163 Acute viral meningitis 121.0
164 Sialadenitis 121.0
165 Unstable angina 120.0
166 Diabetic Kidney Disease 120.0
167 Chronic Mitral regurgitation 119.0
168 Osteomyelitis 119.0
169 Acute Lymphoblastic leukemia in children 119.0
170 Central hypothyroidism 118.0
171 Abnormal uterine bleeding 118.0
172 Acute peptic ulcer 117.0
173 Chronic bacterial prostatitis 117.0
174 Kawasaki disease 117.0
175 Chronic pyelonephritis 117.0
176 Mitral Stenosis 116.0
177 Animal bites 116.0
178 Non-small cell lung cancer 116.0
179 Umbilical hernia 116.0
180 Bladder Cancer 116.0
181 Lung Cancer 115.0
182 mucosal Eosinophilic gastroenteritis 114.0
183 Adrenal crisis 114.0
184 Stable angina 113.0
185 Benign Prostatic Hyperplasia 112.0
186 Priapism 112.0
187 Acute fatty liver of pregnancy 112.0
188 Androgenetic alopecia 112.0
189 Adrenal Suppression 111.0
190 subserosal eosinophilic gastroenteritis 109.0
191 Hypercalcemia 109.0
192 Autosomal Dominant Polycystic Kidney Disease 108.0
193 Acute respiratory failure 108.0
194 Infectious mononucleosis 107.0
195 Intraperitoneal bleeding 106.0
196 Acute Pancreatitis 106.0
197 Hypothyroidism 106.0
198 Malaria 106.0
199 Psychogenic polydipsia 106.0
200 Churg-Strauss Syndrome 105.0
201 Secondary hyperparathyroidism 104.0
202 Intestinal Pseudo Obstruction 103.0
203 Achalasia 101.0
204 Gestational diabetes mellitus 101.0
205 Tetanus 99.0
206 Anemia of chronic disease 99.0
207 Foreign body ingestion 99.0
208 ST-elevation myocardial infarction 98.0
209 Diverticulitis 96.0
210 Gastric Volvulus 96.0
211 Campylobacter infection 95.0
212 Gallstone pancreatitis 94.0
213 Portal hypertension 93.0
214 Acute peritonitis 93.0
215 Anthrax 93.0
216 Acetaminophen overdose 93.0
217 Chronic Myeloid Leukemia 92.0
218 Dermatophyte infections 92.0
219 Simple kidney cyst 91.0
220 Gastroesophageal reflux disease 90.0
221 Influenza 90.0
222 Pheochromocytoma 90.0
223 Meckel diverticulum 90.0
224 Acute Appendicitis 89.0
225 Ileus 89.0
226 Acne fulminans 88.0
227 Acne conglobata 88.0
228 Gram-negative folliculitis 88.0
229 Excoriated acne 88.0
230 Candidiasis 88.0
231 Candidal intertrigo 88.0
232 Candida Balanitis 88.0
233 Oropharyngeal and esophageal candidiasis 88.0
234 Vulvovaginal candidiasis 88.0
235 Inflammatory Bowel Diseases 87.0
236 Acute pericarditis 86.0
237 Multiple endocrine neoplasia 2A 86.0
238 Pancreatic Pseudocyst 84.0
239 Acute perforated appendicitis 84.0
240 Intestinal malrotation 84.0
241 Familial adenomatous polyposis syndrome 83.0
242 Duodenal Ulcer 82.0
243 Gastric Ulcer 82.0
244 Acute pelvic inflammatory disease 82.0
245 Acute Lymphocytic Leukemia in Adults 82.0
246 Acute disseminated encephalomyelitis 82.0
247 Musculoskeletal sprains and strains 82.0
248 Familial Mediterranean fever 82.0
249 Lactose intolerance 81.0
250 Heparin-induced thrombocytopenia 81.0
251 Acute Clonorchiasis 80.0
252 Multiple Sclerosis 79.0
253 Menopause 78.0
254 Goiter 78.0
255 Diffuse nontoxic goiter 78.0
256 Toxic multinodular goiter 78.0
257 Cervical goiter 78.0
258 Peptic Ulcer 77.0
259 Eosinophilic gastroenteritis 77.0
260 Tinea versicolor 77.0
261 Alopecia areata 77.0
262 Atypical pneumonia 77.0
263 Hypoparathyroidism 76.0
264 Toxic thyroid adenoma 76.0
265 Extraintestinal Entamoeba histolytica amebiasis 76.0
266 biliary colic 75.0
267 Acute Hepatitis 75.0
268 Ruptured ovarian cyst 75.0
269 Splenic Infarction 75.0
270 Intestinal Entamoeba histolytica amebiasis 74.0
271 Sunburn 73.0
272 Malt lymphoma 72.0
273 Obstructive cervical goiters 72.0
274 Shigellosis 71.0
275 Aortic stenosis 70.0
276 Systemic vasculitis 70.0
277 Chronic Clonorchiasis 69.0
278 Gastritis 69.0
279 Cholera 69.0
280 Chronic Lymphocytic Leukemia 69.0
281 Multiple endocrine neoplasia 2B 69.0
282 Pseudohypoparathyroidism 69.0
283 Irritable Bowel Syndrome 68.0
284 Hiatus hernia 68.0
285 Angle Closure Glaucoma 68.0
286 Croup 68.0
287 Clonorchiasis 68.0
288 Acne vulgaris 67.0
289 STI HIV Pharyngitis 66.0
290 Psoriatic arthritis 66.0
291 Torsion of appendix of testis 65.0
292 Abetalipoproteinemia 64.0
293 COVID19 63.0
294 Medullary thyroid cancer 63.0
295 Fibromyalgia 62.0
296 Multiple Myeloma 62.0
297 Acalculous Cholecystitis 61.0
298 chronic acalculous cholecystitis 61.0
299 Amebiasis 61.0
300 Asthma 60.0
301 Foodborne E coli infection 60.0
302 Annular pancreas 58.0
303 Extrahepatic Cholestasis 58.0
304 Intrahepatic Cholestasis 58.0
305 Insect bites and stings 58.0
306 Anaplastic thyroid cancer 58.0
307 Prolactinoma 58.0
308 Chronic Renal vein thrombosis 55.0
309 Typhoid infection 55.0
310 Acute Rhinosinusitis 55.0
311 Rocky Mountain spotted fever 54.0
312 Chronic pelvic pain in women 53.0
313 Inguinal hernia 52.0
314 Oropharyngeal cancer 52.0
315 Allergic rhinitis 51.0
316 Acute otitis media 50.0
317 Choledochal Cyst 50.0
318 Varicocele 50.0
319 Acute Cholangitis 50.0
320 Travelers diarrhea 50.0
321 Charcot-Marie-Tooth Disease 48.0
322 Chlamydia pneumoniae infection 48.0
323 Acute cervical spine trauma 46.0
324 Ovarian Torsion 46.0
325 Osteoarthritis 45.0
326 Acute bacterial rhinosinusitis 45.0
327 Acute viral rhinosinusitis 45.0
328 Zollinger-Ellison Syndrome 44.0
329 Discogenic low back pain 44.0
330 Common cutaneous drug reactions 42.0
331 Rumination Syndrome 42.0
332 Epiploic appendagitis 41.0
333 Empyema 41.0
334 Common cold(adults) 41.0
335 Drowning 41.0
336 Gilbert syndrome 40.0
337 Pressure ulcer 39.0
338 Intrahepatic cholestasis of pregnancy 38.0
339 Hypogammaglobulinemia 38.0
340 Acute Myeloid Leukemia in children 38.0
341 Acute heart failure 37.0
342 Uveitis 36.0
343 Anterior uveitis 36.0
344 Intermediate uveitis 36.0
345 Posterior uveitis 36.0
346 Pan uveitis 36.0
347 Exocrine pancreatic insufficiency 34.0
348 Chronic meningitis 34.0
349 Bacterial gastroenteritis 34.0
350 Aseptic meningitis 34.0
351 Male factor infertility 33.0
352 Ichthyosis 33.0
353 Migraine 32.0
354 Non-cholera Vibrio infections 31.0
355 Milk-alkali syndrome 31.0
356 Acute Milk-alkali syndrome 31.0
357 Chronic Milk-alkali syndrome 31.0
358 Listerial gastroenteritis 30.0
359 Osteomalacia 30.0
360 Autoimmune hemolytic anemia 30.0
361 Pharyngitis 30.0
362 Herpes pharyngitis 30.0
363 Ruptured Tuboovarian abscess 29.0
364 Penis Carcinoma 28.0
365 Paraneoplastic Syndromes 28.0
366 Acute epididymitis 28.0
367 Testicular cancer 28.0
368 Migraine headache in adults 27.0
369 Substernal goiter 27.0
370 cholestatic liver disease 27.0
371 Viral pharyngitis 27.0
372 Parkinson disease 27.0
373 Peritoneal dialysis associated peritonitis 26.0
374 Primary ciliary dyskinesia 25.0
375 Kartagener syndrome 25.0
376 Keloid 25.0
377 biliary SOD 24.0
378 Zenker diverticulum 23.0
379 Limited cutaneous systemic sclerosis 22.0
380 Gallbladder Dyskinesia 20.0
381 Bed bugs 20.0
382 Nasal polyps 20.0
383 Endometriosis 20.0
384 chronic cholestatic liver disease 20.0
385 Acute Mitral regurgitation 20.0
386 Acute atrial fibrillation 19.0
387 Thyroid lymphoma 19.0
388 Hyperglycemia 18.0
389 Laryngeal Cancer 18.0
390 Primary hypogonadism 18.0
391 Phenylketonuria 18.0
392 Acute Bronchitis 17.0
393 Splenic abscess 14.0
394 Peroneal Neuropathy 14.0
395 Fungal meningitis 14.0
396 Common cold(children) 13.0
397 Thrombotic thrombocytopenic purpura 13.0
398 Optic neuritis 13.0
399 Neuropapillitis 13.0
400 Herpes zoster 12.0
401 Pulmonary Embolism 11.0
402 Rotor syndrome 11.0
403 Bullous pemphigoid 10.0
404 Psoriasis 10.0
405 Immune thrombocytopenia 9.0
406 Hemorrhoids 9.0
407 Acute Bacterial Prostatitis 9.0
408 Endometritis 9.0
409 Mallory-Weiss syndrome 9.0
410 Scleritis 8.0
411 Anterior scleritis 8.0
412 Posterior scleritis 8.0
413 Disseminated intravascular coagulation 8.0
414 Periorbital and orbital cellulitis 6.0
415 Pelvic inflammatory disease 6.0
416 endocarditis 1.0
417 Essential Tremor 0.0
418 Trachoma 0.0
419 Myasthenia Gravis 0.0
420 Neonatal Myasthenia Gravis 0.0
421 Congenital Myasthenic Syndromes 0.0
422 Pulmonary regurgitation 0.0
423 Panic disorder in adults 0.0
424 Orthostatic hypotension 0.0
425 Globus Sensation 0.0
426 Recurrent aphthous stomatitis 0.0
427 Acute Cystitis(Men) 0.0
428 Visceral leishmaniasis 0.0
429 Musculoskeletal lower back pain 0.0