Ascites diagnosis

Rubinstein, D., Mclnnes, I.E., Dudiey, F.J. Hepatic hydrothorax in the absence of clinical ascites. Diagnosis and management. Gastroenterology 1985 88 188-191... 

Signs and symptoms of SBP in a patient with cirrhosis and ascites should prompt a diagnostic paracentesis (Fig. 19-4). In SBP, there is decreased total serum protein, elevated white blood cell count (with left shift), and the ascitic fluid contains at least 0.250 x 103/mm3 (0.250 x 109/L) neutrophils. Bacterial culture of ascitic fluid may be positive, but lack of growth does not exclude the diagnosis. 

Greco, A. V., Mingrone, G., Gasbarrini, G. Clin. Chim. Acta 239, 1995, 13-22. Free fatty acid analysis in ascitic fluid improves diagnosis in malignant abdominal tumors. 

Hepatic venous thrombosis, also known as Budd-Chiari syndrome, is caused by hypercoagulable disorders precipitated by pregnancy, infection, and birth control medication. An acute painful abdomen, sudden enlargement of the liver, and the presence of ascites make up a triad of clinical symptoms that are important in the diagnosis of this syndrome. Myeloproliferative disorders such as polycythemia vera and paroxysmal nocturnal dyspnea were previously thought to be responsible. Factor V Leiden and prothrombin 20210 mutations are also known to be responsible, Other intraabdominal thromboses include portal vein thrombosis, mesenteric vein thrombosis and renal vein thrombosis. 

Ovarian cancer patients with progressed disease often present with ascites/ peritoneal fluid. In some women, ovarian cysts are detected containing cystic fluid. The concentrations of suPAR in these body fluids were compared with those in serum made from peripheral blood and blood aspirated from the surface veins on the tumor in 77 patients admitted for surgery of ovarian tumors [21]. In this study, elevated levels of suPAR were measured in serum from peripheral blood and tumor blood in the patients with more advanced disease. However, the concentrations of suPAR in the body fluids were quite different, in serum the measured concentrations were between 46 and 98 pmol/liter, in ascites/peritoneal fluid concentrations were between 293 and 586 pmol/liter, and in cystic fluids the concentrations were even higher, that is 651-8468 pmol/liter. The concentrations of suPAR in cystic fluids clearly separated benign and malignant cysts with predictive values above 90%. The levels of suPAR in cystic fluids could therefore be used in the early diagnosis of ovarian cancer patients. The suPAR in the cystic fluids was present both in intact and cleaved forms and at least some of the suPAR(I-III) was not occupied by uPA [21]. In another study, tumor tissue, serum, ascites, and urine from ovarian cancer patients were analyzed for their content of the different uPAR forms. Whereas all of tumor lysates, ascites, and urine contained uPAR(I-III) and uPAR(II-III), domain I was only present in urine samples. In serum, only intact suPAR was detected [82], The antibodies used for identification were mAb R3 (domain I) and mAb R2 (domain III). 

About 50% of patients with cirrhosis develop ascites within 10 years of diagnosis and 50% of these will die within 2 years. The process by which ascites forms in cirrhosis is not fully understood but appears to involve the accumulation of vasodilator substances, activation of the renin-angiotensin-aldosterone system (causing renal retention of sodium and water), and the production of antidiuretic hormone (causing hyponatraemia due to dilution, not deficiency, of plasma sodium). 

Numerous diseases can cause ascites. In terms of aetiology, liver diseases, malignant processes and chronic cardiac diseases rank right at the top. Yet inflammatory, renal, metabolic, vascular and endocrinological causes also have to be borne in mind when drawing up a differential diagnosis. The mechanisms at work in the formation of ascites are often still unresolved, as is the case, for example, in hypothyroidism, diseases of the ovaries or the POEMS syndrome (P.A. Bardwick et al., 1980). (100,168) (s. tab. 16.6)... 

Sonography Sonography facilitates the diagnosis of ascites in its early stages (< 200 ml). If the fluid accumu-... 

Spontaneous bacterial empyema is found in 1-2% of patients with cirrhosis and ascites. The diagnosis is based on a positive bacterial test in the pleural fluid and a WBC count in excess of 250/mm (or a negative bacterial culture with a cell count exceeding 500/mm ) - which is analogous to spontaneous bacterial peritonitis. (105) (s. p. 302)... 

Cell count The second important criterion of SBP is deemed to be a higher cell count (>250 polymorphonuclear neutrophils/mm ). As a result, early diagnosis is possible with a sensitivity of 92% and a specificity of 95%. A higher leukocyte count in ascitic fluid does not correlate with peripheral leukocytosis (or vice versa). Mechanical assessment of the cell count, however, also identifies lymphocytes, serosal surface cells and peritoneal macrophages. For this reason, it is imperative to distinguish the polymorphonuclear neutrophils (and possibly the number of mononuclear forms) in the ascitic fluid smear. (71, 75, 79,102,106)... 

Bansal, S., Kaur, K., Bansal, A.K. Diagnosis ascitic etiology on a biochemical basis. Hepato-Gastroenterol. 1998 45 1673-1677... 

Colli, A., Buccino, G., Cocciolo, M., Parravicini, R., Mariani, F., Scal-trini, G. Diagnostic accuracy of fibronectin in the differential diagnosis of ascites. Cancer 1986 58 2489-2493... 

Gitlin, N., Stauffer, J.L., Silvestri, R.C. The pH of ascitic fluid in the diagnosis of spontaneous bacterial peritonitis in alcoholic patients. Hepatology 1992 2 406-411... 

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