Ascites: Causes, Investigations, and Diagnostic Criteria

Ascites: Causes, Investigations, and Diagnostic Criteria

Question. Write a short note on the causes and investigations of ascites.

Answer.

Causes of Ascites

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1. Disease of peritoneum

1. Infections:

• Tuberculous peritonitis.
• Spontaneous bacterial peritonitis.
• Fungal: Candida, histoplasma.
• Parasitic: Schistosoma, enterobius.
• Viral: Acute severe hepatitis.

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2. Neoplasms:

• Primary mesothelioma.
• Secondary carcinomatosis, e.g. adenocarcinoma,
• sarcoma, teratoma, leukemia, Hodgkin’s disease,
• lymphocytic lymphoma, myeloid metaplasia.
• Pseudomyxoma peritonei

3. Familial paroxysmal peritonitis

4. Miscellaneous:

• Vasculitis — SLE and other collagen vascular
• diseases, allergic vasculitis (Henoch­Schönlein purpura).
• Eosinophilic gastroenteritis.
• Whipple’s disease.
• Granulomatous peritonitis — Sarcoidosis,
• Crohn’s disease, starch peritonitis.
• Peritoneal loose bodies.
• Peritoneal encapsulation.

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2. Portal hypertension

3. Congestive heart failure

4. Hypoalbuminemia:

• Nephrosis
• Malnutrition
• Protein­losing enteropathy

5. Beriberi

6. Myxedema

7. Ovarian disease:

• Meigs’syndrorne
• Struma ovari
• Ovarian overstimulation syndrome

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8. Pancreatic ascites due to retroperitoneal leakage of pancreatic enzymes from a ruptured cyst or pancreatic duct.

9. Bile ascites

10. Chylous ascites

11. Epidemic dropsy

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Investigations Ascites

• Blood examination: Anemia can be present. Presence of neutrophilic leukocytosis indicates infection.
• Urine examination: Massive albuminuria greater than 3.5 gm per day is present in nephritic syndrome.
• Stool for occult blood: It may indicate gastrointestinal malignancy as cause for ascites.
• Ultrasonography: It detect ascites
• Diagnostic paracentesis: 50–100 mL of ascetic fluid is aspirated and biochemical analysis is done. Bacteriological examination should also be done. It should detect whether the ascetic flid is exudate or transudate.
• Serum-ascites albumin gradient: Albumin present in serum and ascetic flid is determined for calculating the gradient.
  Gradient > 1.1 g / dL indicates transudative ascites and < 1.1 g / dL indicate exudative ascites.
  Fluid protein < 50% of serum protein indicates transudate while > 50% is indicative of exudates.