Aetiology of Ascites and Diagnostic Value of Ascitic Fluid Analysis

Ascites is an important feature of many diseases, mainly liver disorder. The aim of this study is to determine the causes of ascites in Nagpur region, and to evaluate the significance of ascitic fluid analysis in different types of ascites. This prospective study was conducted at Govt. Medical College Nagpur. It involved patients admitted with primary diagnosis of ascites, over a period of 1 year, (may 2007-may 2008). The total number of patients included in this study was 69 out of which 61 (88.4%) were male and 8(11.59%) were female, with a mean age 49.88 ± 8.86 years. Liver cirrhosis was the most frequent cause of ascites in 47 (62.23%) patients. Based on the serum-ascites albumin gradient (SAAG), different causes of ascites were divided into two main groups. The first group was characterised by a mean SAAG of 1.1 or higher, and the second group was characterised by a mean SAAG of less than 1.1. The most common cause of high gradient ascites were liver cirrhosis and heart failure while the most common causes of low gradient ascites were tuberculousis and neoplasm. The mean ascitic albumin concentration was higher in heart failure patients than in cirrhotic patients (p<0.05).The mean ascitic lactate dehydrogenase (LDH) level and the mean ascitic glucose concentration was higher in cancer patients than in tuberculous patients (p<0.05). Liver cirrhosis is the main cause of ascites in cases reported to GMC, Nagpur. SAAG is a better distinguishing marker for separating ascites related to portal hypertension from other causes of ascites without portal hypertension. In patients with low gradient ascites, ascitic fluid glucose and LDH level are useful indicators for separating tuberculous from malignant ascites.