Ascites differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Ascites}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Ascites]]


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{{CMG}}; {{AE}} {{EG}}


==Overview==
==Overview==
Diseases that cause ascites should differentiate from each others, such as cirrhosis, [[Alcoholic hepatitis]], [[Budd-Chiari  syndrome]], [[Constrictive pericarditis]], [[Heart failure]], [[Myxedema]], [[Cancer]], [[Nephrotic syndrome]], [[Pancreatitis]], [[Serositis]], and [[Tuberculosis]]. The ascites may be [[transudate]] ([[Serum-ascites albumin gradient|serum-ascites albumin gradient [SAAG]]] ≥ 1.1 g/dL) or exudate ([[Serum-ascites albumin gradient|serum-ascites albumin gradient [SAAG]]] < 1.1 g/dL).


==Differentiating Cirrhosis from other Diseases==
==Differentiating Other Diseases Caused Ascites==
 
* Diseases that cause ascites should differentiate from each others, such as cirrhosis, [[Alcoholic hepatitis]], [[Budd-Chiari  syndrome]], [[Constrictive pericarditis]], [[Heart failure]], [[Myxedema]], [[Cancer]], [[Nephrotic syndrome]], [[Pancreatitis]], [[Serositis]], and [[Tuberculosis]].  
Ascites may be caused by portal hypertension due to cirrhosis of liver or due to other causes like malignancies etc.,
* The ascites may be [[transudate]] ([[Serum-ascites albumin gradient|serum-ascites albumin gradient [SAAG]]] ≥ 1.1 g/dL) or exudate ([[Serum-ascites albumin gradient|serum-ascites albumin gradient [SAAG]]] < 1.1 g/dL).
 
<small>
Ascitic fluid analysis should be done to broadly categorize the cause of ascites.
<small>
 
{|
Ascites is broadly classified as two types based on the [[Serum-ascites albumin gradient]] (SAAG):
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
* Transudate - SAAG > 1.1 g/dL (indicates the ascites is due to [[portal hypertension]]).
! rowspan="3" |Type
* Exudate - SAAG < 1.1 g/dL (indicates the ascites is due to non-portal hypertension etiology).
! rowspan="3" |Diseases
! colspan="8" |History and Symptoms
! colspan="6" rowspan="2" |Physical Examination
! colspan="7" |Laboratory Findings
! rowspan="3" |Other Findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="4" |GI symptoms
! colspan="4" |Extra-GI symptoms
! colspan="4" |Liver function test
! colspan="3" |Biochemical test
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Jaundice
!Abdominal pain
!Hematemesis
!Nausea
!Weight loss
!Dyspnea
!Cough
!Chest pain
!Fever
!Spider angioma
!Abdominal tenderness
!Jugular venous distention
!Pitting edema
!Muffled heart sounds
!ALT
!AST
!Bili
!Amylase /Lipase
!Cr
!ESR
!Na-K
|-
| rowspan="7" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Transudate]]
([[SAAG]]≥ 1.1g/dL)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cirrhosis]]
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |
* [[Esophageal varices]]
* [[Gynecomastia]]
* [[Testicular atrophy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Alcoholic hepatitis]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑↑↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |
* [[Fatty liver disease]]
* [[Loss of appetite]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Budd-Chiari  syndrome]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |
* [[Hepatosplenomegaly]]
* [[Hypercoagulability|Hypercoagulopathy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Constrictive pericarditis]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |
* [[Pulsus paradoxus]]
* [[Fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Heart failure]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |
* Declined functional class
* [[Fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myxedema]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |↓
| style="background: #F5F5F5; padding: 5px;" |
* [[Generalized edema]]
* Low [[body temperature]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Portal hypertension]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |
* [[Esophageal varices]]
* [[Hepatosplenomegaly]]
|-
| rowspan="5" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Exudate]]
([[SAAG]]< 1.1g/dL)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cancer]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" | -
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nephrotic syndrome]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |
* [[Proteinuria]]
* [[Hypoalbuminemia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pancreatitis]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |
* Radiating [[pain]] to back
* [[Gallstone]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Serositis]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" | -
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tuberculosis]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |
* [[Chronic cough, severe cold|Chronic cough]]
* [[Night sweat]]
|}
</small>
</small>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Needs content]]
[[Category: Medicine]]
[[Category: Up-To-Date]]
[[Category: Gastroenterology]]
[[Category: Hepatology]]
[[Category: Emergency medicine]]
 


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 22:09, 8 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Diseases that cause ascites should differentiate from each others, such as cirrhosis, Alcoholic hepatitis, Budd-Chiari syndrome, Constrictive pericarditis, Heart failure, Myxedema, Cancer, Nephrotic syndrome, Pancreatitis, Serositis, and Tuberculosis. The ascites may be transudate (serum-ascites albumin gradient [SAAG] ≥ 1.1 g/dL) or exudate (serum-ascites albumin gradient [SAAG] < 1.1 g/dL).

Differentiating Other Diseases Caused Ascites

Type Diseases History and Symptoms Physical Examination Laboratory Findings Other Findings
GI symptoms Extra-GI symptoms Liver function test Biochemical test
Jaundice Abdominal pain Hematemesis Nausea Weight loss Dyspnea Cough Chest pain Fever Spider angioma Abdominal tenderness Jugular venous distention Pitting edema Muffled heart sounds ALT AST Bili Amylase /Lipase Cr ESR Na-K
Transudate

(SAAG≥ 1.1g/dL)

Cirrhosis ++ + + + + - - - - + + - - - ↑↑ ↑↑ ↑↑ Normal Normal Normal Normal
Alcoholic hepatitis - - - + + - - - + - - - - - ↑ ↑↑↑ Normal Normal Normal Normal Normal
Budd-Chiari syndrome - + - + + - - - + - - - - - ↑ ↑ Normal Normal Normal ↑ Normal
Constrictive pericarditis - - - - - + - + + - - ++ - + Normal Normal Normal Normal Normal ↑ Normal
Heart failure - - - - + + + + - - - + + - Normal Normal Normal Normal Normal Normal ↑
Myxedema - - - - - + - - - - - - ++ - Normal Normal Normal Normal Normal Normal ↓
Portal hypertension +/- + + + + - - - - + - - - - ↑ ↑ ↑ Normal ↑ Normal Normal
Exudate

(SAAG< 1.1g/dL)

Cancer + + - + ++ - - - - - - - - - Normal Normal Normal Normal Normal ↑↑ Normal -
Nephrotic syndrome - - - + - - - - - - - - ++ - Normal Normal Normal Normal ↑↑ ↑ ↑↑
Pancreatitis +/- +++ - ++ - - - + + - ++ - - - Normal Normal Normal ↑↑ Normal ↑ Normal
Serositis - + - + + - - +/- + - + - - - Normal Normal Normal Normal Normal ↑ Normal -
Tuberculosis - + - + + ++ ++ ++ +/- - + - - - Normal Normal Normal Normal Normal ↑↑ Normal

References


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