I saw a twenty-one year old male patient at the emergency room the other day. He’s abdomen was so big, he looked like he’s pregnant!
So I took a medical history like all doctors do. It turned out that his problem started about 3 months ago, he’s having cough, fever, and remarkable weight loss (17 pounds in 2 months!).
Chest x-ray’s showed fluid in the right lung. CT Scans showed enlarged lymph nodes in the abdomen.
It was a toss between malignancy versus tuberculosis.
He has milk!
Since he was breathing heavily, and his belly was distended, we did a paracentesis. Paracentesis is just a fancy term for taking fluid out of your body (the abdomen). The fluid, called peritoneal fluid, is secreted by a lining of cells in your body. Various conditions could lead to a building up of this fluid (called ascites) like decompensated liver cirrhosis, infections, cancer, etc.
Usually, the fluid would just look like plasma. Yellowish, and clear. This guy’s fluid is milky! We were all surprised. There’s a fancy term for this : Chylous Ascites.
It looks like milk, but it isn’t milk. The fluid is called “chyle†which is the fluid that flows from your lymph nodes. It’s white because it’s made up of fat known as triglycerides. You need to have a level of 100mg/dL in your peritoneal fluid to have chylous ascites. This patient’s got 12,500 mg/dL!!
On further work-up, we found out this patient has disseminated tuberculosis. It’s a very treatable bacteria. And very contagious.
Oh, this fellow works as a waiter in some fast food joint.
