A chest x-ray of transfusion-related acute lung injury (left) which led to ARDS. Right is a normal X-ray before the injury. Diagnostic criteria Diagnostic criteria for ARDS have changed over time as understanding of the pathophysiology has evolved. The international consensus criteria for ARDS were most recently updated in 2012 and are known as the "Berlin definition". In addition to generally broadening the diagnostic thresholds, other notable changes from the prior 1994 consensus criteria include discouraging the term "acute lung injury," and defining grades of ARDS severity according to degree of decrease in the oxygen content of the blood. According to the 2012 Berlin definition, adult ARDS is characterized by the following: * lung injury of acute onset, within 1 week of an apparent clinical insult and with the progression of respiratory symptoms * bilateral opacities on chest imaging (chest radiograph or CT) not explained by other lung pathology (e.g. effusion, lobar/lung collapse, or nodules) * respiratory failure not explained by heart failure or volume overload * decreased Pa/Fi ratio (a decreased Pa/Fi ratio indicates reduced arterial oxygenation from the available inhaled gas): *mild ARDS: 201 – 300 mmHg (≤ 39.9 kPa) *moderate ARDS: 101 – 200 mmHg (≤ 26.6 kPa) *severe ARDS: ≤ 100 mmHg (≤ 13.3 kPa) *Note that the Berlin definition requires a minimum positive end expiratory pressure (PEEP) of 5 cm for consideration of the Pa/Fi ratio. This degree of PEEP may be delivered noninvasively with CPAP to diagnose mild ARDS. Note that the 2012 "Berlin criteria" are a modification of the prior 1994 consensus conference definitions (see history). Medical imaging Radiologic imaging has long been a criterion for diagnosis of ARDS. Original definitions of ARDS specified that correlative chest X-ray findings were required for diagnosis, the diagnostic criteria have been expanded over time to accept CT and ultrasound findings as equally contributory. Generally, radiographic findings of fluid accumulation (pulmonary edema) affecting both lungs and unrelated to increased cardiopulmonary vascular pressure (such as in heart failure) may be suggestive of ARDS. Ultrasound findings suggestive of ARDS include the following: * Anterior subpleural consolidations * Absence or reduction of lung sliding * "Spared areas" of normal parenchyma * Pleural line abnormalities (irregular thickened fragmented pleural line) * Nonhomogeneous distribution of B-lines (a characteristic ultrasound finding suggestive of fluid accumulation in the lungs)
complications of Peritonitis
complications of Ascites
medical cause of Peritonitis
complications of Gallstone
complications of Acute liver failure
medical cause of Abdominal pain
complications of Diverticulitis
complications of Typhus