Cirrhotic Liver Disease & Ascites PDF

(Cirrhotic liver disease). Measurement of the protein concentration and the serum ascites albumin gradient (SAAG) can be a useful tool to distinguish ascites of different aetiologies. Cirrhotic patients typically develop ascites with a low protein concentration ('transudate'; protein concentration...

(Cirrhotic liver disease). Measurement of the protein concentration and the serum ascites albumin gradient (SAAG) can be a useful tool to distinguish ascites of different aetiologies. Cirrhotic patients typically develop ascites with a low protein concentration ('transudate'; protein concentration 30 g/L (3.0 g/dL). In these cases, it is useful to calculate the SAAG by subtracting the concentration of the ascites fluid albumin from the serum albumin. A gradient of > 11 g/L (1.1 g/dL) is 96% predictive that ascites is due to portal hypertension. Venous outflow obstruction due to cardiac failure or hepatic venous outflow obstruction can also cause a transudative ascites, as indicated by an albumin gradient of > 11 g/L (1.1 g/dL) but, unlike in cirrhosis, the total protein content is usually > 25 g/L (2.5 g/dL). High protein ascites ('exudate'; protein concentration > 25 g/L (2.5 g/dL) or a SAAG of < 11 g/L (1.1 g/dL) raises the possibility of infection (especially tuberculosis), malignancy, pancreatic ascites or, rarely, hypothyroidism. Ascites amylase activity of > 1000 U/L identifies pancreatic ascites, whereas low ascites glucose concentrations suggest malignant disease or tuberculosis. Cytological examination may reveal malignant cells (one-third of cirrhotic patients with a bloody tap have a hepatocellular carcinoma). Polymorphonuclear leucocyte counts of >250 × 10 to the power of 6/L strongly suggest infection (spontaneous bacterial peritonitis). Laparoscopy can be valuable in detecting peritoneal disease. The presence of triglyceride at a level > 1.1 g/L (110 mg/dL) is diagnostic of chylous ascites and suggests anatomical or functional abnormality of lymphatic drainage from the abdomen. The ascites in this context has a characteristic milky-white appearance. (Transudate) (Exudate)