Ascites fluid bilirubin

Bile pigments also occur in the pleural and ascitic fluids of jaundiced patients. According to Keller (K3) tumor exudates of the inflammatory type may contain more bilirubin than is present in the plasma. 

Elis, A., Meisel, S., Tishler, T., Kitai, Y., Lishner, M. Ascitic fluid to serum bilirubin concentration ratio for the classification of transudates or exudates. Amer. X Gastroenterol. 1998 93 401-403... 

A 10-yr-old British boy was diagnosed with Crohn s disease and was treated with an herbal tea containing comfrey leaf. Other medications included sporadic use of prednisolone and sulfasalazine. Three years later, he presented with weight loss, diarrhea, fever, abdominal pain, ascites, tender hepatomegaly, and fatigue. Laboratory tests revealed mild iron deficiency anemia (Hgb 117 g/L), elevated bilirubin (26 mmol/L) and aspartate aminotransferase level (87 IU/L), and low serum albumin. Ascitic fluid protein concentration was 27 g/L. Liver biopsy showed the thrombotic variant of venoocclusive disease. He was treated with salt restriction and spironolactone, with good response. 

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