IJAR - Indian Journal of Applied Research

Dr Yogesh  Kumar Dhandh; Dr Narayan Jeet Singh; Dr Madhu Lata Rana

Volume : VII, Issue : II, February - 2017

TO STUDY THE ROLE OF ASCITIC FLUID CHOLESTEROL IN DIFFERNTIAL DIAGNOSIS OF ASCITES

Dr Yogesh Kumar Dhandh, Dr Narayan Jeet Singh, Dr Madhu Lata Rana

Abstract :

Ascites is defined as the presence of free fluid within peritoneal cavity. In most cases ascites appears as a part of well recognized illness i.e. cirrhosis, congestive heart failure, tubercular peritonitis, nephrosis, disseminated carcinomas, etc.

AIMS AND OBJECTIVES–To study ascitic fluid cholesterol levels in various types of ascites , to study SAAG (serum ascites albumin gradient) in various types of ascites ,to compare diagnostic values of ascitic fluid cholesterol levels v/s SAAG and to find out specificity & sensitivity of ascitic fluid cholesterol levels in differential diagnosis of ascites.

MATERIAL AND METHODS– The study was conducted on 100 patients of ascites of different etiologies admitted in Govt. Medical College and associated group of Hospitals, Kota of 15–65 years of either sex. The following study groups were made viz.:–

Group I 25 Cases of ascites caused by cirrhosis of liver

Group II 25 cases of ascites caused by Tuberculosis

Group III 25 cases of ascites caused by Malignancies

Group IV 25 cases of ascites caused by others (e.g. CHF, CRF, Nephrotic Syndrome, Anemia–hypoproteinemia, Bacterial Peritonitis, etc.)

The paracentesis was performed after proper positioning of patient . 150 ml. of ascitic fluid was drawn and examined for gross appearance, total protein, albumin, adenosine deaminase (ADA) (when indicated), sugar, cholesterol, total cell count, cell type, malignant cells, acid fast bacilli (AFB), Gram staining, aerobic and anaerobic culture (when indicated). Liver function test, Serum cholesterol, Sputum for AFB and culture (When indicated), ECG, Chest X–ray ,X–ray abdomen , Ultrasonography of abdomen: Histopathological examination, Upper GI endoscopy, Ascitic fluid examination–Gross appearance , Colour ,Total protein (Both Ascitic fluid and serum) estimated through Biuret method (Wottern, 1964) Albumin (Both for ascitic fluid and serum) By Dumans et al (Bromocresol Dye Method) Globulin Sugar Cholesterol Ascitic fluid cytology (Kolmer and Boerner) were also done when indicated. EXCLUSION CRITERIA – Following patients were excluded from the study :– Haemodynamically unstable patients: Blood pressure less than 90 mmHg. Arterial hypotension may result in a decrease in the portal pressure and a narrowing of the SAAG , Bleeding abnormality: Coagulopathy, When there is clinically evident fiinolysis or clinically evident disseminated intravascular coagulation.

CONCLUSION–Ascitic fluid cholesterol is an easy, cheap and reliable biochemical parameter to differentiate (cirrotic) transudative and other ascites from malignant ascites but is not useful in differentiating cirrhotic (transudative) and others from tubercular ascites