TO STUDY THE ROLE OF ASCITIC FLUID CHOLESTEROL IN DIFFERNTING MALIGNANT AND TUBERCULAR ASCITES

Dr Yogesh Kumar Dhandh; Dr. Arun Pandey

Volume : IX, Issue : V, May - 2020

TO STUDY THE ROLE OF ASCITIC FLUID CHOLESTEROL IN DIFFERNTING MALIGNANT AND TUBERCULAR ASCITES

Dr Yogesh Kumar Dhandh, Dr. Arun Pandey

Abstract :

Ascites is deﬁned as the presence of freet 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 two types of ascites–Malignant and Tubercular , to study SAAG (serum ascites albumin gradient) in both 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 diﬀerenting malignant and tubercular 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 50 cases of ascites caused by Tuberculosis Group II 50cases of ascites caused by Malignancies 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 tubercular ascites from malignant ascites.