FREQUENCY OF CAUSES OF ASCITES IN PATIENTS ADMITTED AT MEDICAL UNIT OF A TERTIARY MEDICAL CARE FACILITY
AbstractBackground: Ascites can be defined as accumulation of free fluid in the peritoneal cavity. It is themost common complication of cirrhosis and is associated with a poor quality of health, increasedrisks of infections, renal failure and a poor long-term outcome. This descriptive analytical studywas conducted on one hundred and fifty diagnosed patients of ascites consecutively admitted inmedical unit of tertiary care facility attached to Muhammad Medical College, Mirpur Khas, Sindh,from Oct 2006 to Sep 2008. Methods: Special proforma was prepared containing patients’ basicinformation, history, clinical findings and investigations necessary to diagnose the cause ofascites. Patients with ascites due to perforation and intraperitoneal bleeding were excluded fromthe study. Serum-ascitic albumin gradient (SAAG) was calculated and patients were grouped intohigh and low SAAG groups. The obtained data was analysed using SPSS-11. Results: In thisstudy 150 patients of ascites were included. Patients were arranged in two groups. High SAAG‘high portal pressure’ group and low SAAG ‘low portal pressure’ group. In high SAAG grouppatients included were 128 (85.33%), and in low SAAG group patients included were 22(14.66%). In high SAAG group, out of 128 (85.33%) patients 122 (81.33%) were of cirrhoticascites, [(viral hepatitis B, C and combined 105 (70%), alcoholic 7 (4.66%), cryptogenic 10(6.66%)], heart failure ascitic patients were 5 (3.33%), and constrictive pericarditis 1 (0.66). Inlow SAAG group out of 22 (14.66%) patients malignant ascites was (primary peritonealcarcinomatosis and metastasis) 11 (7.33%), tuberculous ascites was 10 (6.66%), and ascites due tonephrotic syndrome was 1 (0.66%). Conclusion: As large number of cases of ascites are due tocirrhosis of liver that has little or no cure in developing countries. Media and NGO’s shouldfurther work to increase awareness of this deadly problem.Keywords: Ascites, SAAG, cirrhosis
Anderson RN, Hyattsville, National Center for Health
Statistics. Deaths: leading causes for 2000. National vital
statistics reports 2002;50(16). Available at:
Moore KP, Wong F. The management of ascites in cirrhosis:
report on the consensus conference of the International Ascites
Club. Hepatology 2003;38:258–66.
Ted Bader, Javaid Fazili & et al. Fluvastatin Inhibits Hepatitis
C Replication in Humans. Am J Gastroenterol 2008;103:1–7.
Lavanchy D. Hepatitis B virus epidemiology, disease burden,
treatment, and current and emerging prevention and control
measures. J Viral Hepat 2004;11:97–107.
Wright TL. Introduction to chronic hepatitis B infection. Am J
Zuberi BF, Afsar S, Quraishy MS. Triple Hepatitis: Frequency
and Treatment Outcome of co/super-Infection of Hepatitis C
and D Among Patients of Hepatitis B. J Coll Physicians Surg
J Ayub Med Coll Abbottabad 2010;22(2)
Mansoor Nadeem & Muhammad Ali Yousaf, The value of
clinical signs in diagnosis of cirrhosis: Pak J Med Sci
Nazishand Z, Inayatullah M. Liver Cirrhosis; clinical
presentation: Professional Med J 2002;9(3):207–12.
Siddiqi AI, Siddiqeh M. Alanine aminotransferase/Aspartate
aminotransferase ratio reversal and prolonged prothrombin
time; a specific indicator of hepatic cirrhosis: J Ayub Med Coll
Farooqi JI, Ahmed H. Predictors of esophageal varices in
patients of liver cirrhosis J Postgrad Med Inst 2007;21(1):60–4.
Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi
G, et al. Definition and diagnostic criteria of refractory ascites
and hepatorenal syndrome in cirrhosis. Hepatology 1996;
Runyon BA, Montano AA, Antillon MR, Irving
MA, McHutchison JG. The serum-ascites albumin gradient is
superior to the exudate-transudate concept in the differential
diagnosis of ascites. Ann Intern Med 1992;117:215–20.
Nadeem MA, Waseem T, Usefullness of SAAG in Evaluation
of Ascites: Pak J Gastroenterol 1999;13(1-2):22–28.
Branco-Ferreira M, Pedro E, Barbosa MA, Carlos AG. Ascites
in hereditary angioedema. Allergy 1998;53:543–5.
Warrell DA, Cox TN, Firth JD, Benz ED. Oxford textbook of
medicine. Oxford: Oxford University Press; 2003.
Nasir Hassan Luck & Anwaar A Khan. Role of Laparoscopy in
the diagnosis of low serum ascites albumin gradient. J Pak Med
Aldo J. Montano-Loza, Herschel A. Predictive Factors for
Hepatocellular Carcinoma in Type 1 Autoimmune Hepatitis:
Am J Gastroenterol 2008;103:1944–51.
Andrew D. Yeoman, Thawab Al-Chalabi. Evaluation of risk
factors in the development of hepatocellular carcinoma in
autoimmune hepatitis: Implications for follow-up and
screening. Hepatology 2008;48:863–70.
Duvoux C, Zanditenas D, Hezode C, Chauvat A, Monin
JL, Roudot-Thoraval F, et al. Effects of noradrenalin and
albumin in patients with type I hepatorenal syndrome: a pilot
study. Hepatology 2002;36:374–80.
Pomier-Layrargues G, Paquin SC, Hassoun Z, Lafortune
M, Tran A. Octreotide in hepatorenal syndrome: a randomized,
double-blind, placebo-controlled, crossover study. Hepatology
Moreau R, Durand F, Poynard T, Duhamel C, Cervoni
JP, Ichaï P, et al. Terlipressin in patients with cirrhosis and type
-1 hepatorenal syndrome: a retrospective multicenter study.
Ortega R, Ginès P, Uriz J, Cárdenas A, Calahorra B, De Las
Heras D, et al. Terlipressin therapy with and without albumin
for patients with hepatorenal syndrome: results of a
prospective, nonrandomized study. Hepatology 2002;36:941–8.
Restuccia T, Guevara M, Gines Alessandria P, De las Heras D,
Calahorra B, et al. Impact of pretransplant treatment of
hepatorenal syndrome (HRS) with vasopressin analogues on
outcome after liver transplantation (LTX): a case-control study.
J Hepatol 2003;38(Suppl 2):69.
Khan DM, Sh Rauf A. Ashfaq M, Waheed I, Bhatti T, Ahmad
S. Frequency of asymptomatic spontaneous bacterial peritonitis
in chronic liver disease patients with first presentation of
ascites. Ann King Edward Med Coll 2004;10(2):144–5.
Iqbal S, Imana N, Alam N. Incidence of Spontaneous Bacterial
Peritonitis in liver Cirrhosis, the causative organisms and
antibiotic sensitivity. J Postgrad Med Inst 2004;18:614–9.
Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo
V, et al. Bacterial infections in cirrhosis: epidemiological
changes with invasive procedures and norfloxacin prophylaxis.
Memon AQ, Memon G, Khaskheli A. Spontaneous Bacterial
Peritonitis in Cirrhosis with Ascites - An Experience at PMCH
Nawabshah. Med Channel 1999;5(1):31–4.
Shiraki H, Shiraki K. Images in clinical medicine. Sclerosing
peritonitis. N Eng J Med 2008;359:293.
Barlas N, Akram J, Abaidullah S. Incidence of
Hepatopulmonary syndrome in Cirrhosis of Liver. Ann King
Edward Med Coll 2004;10(3):211–4.
Roberto Rodríguez-Roisin and Michael J. Krowka.
Hepatopulmonary Syndrome: A Liver-Induced Lung Vascular
Disorder. N Eegl J Med 2008;358:2378–87.
Kiyani KA, Bux H, Khan MA, Qazi SA.Shortness of breathing
caused by pleuropericardial effusion & ascities due to
idiopathic cirrhosis of liver. Pak J Chest Med 2005;11(2):13–5.
Abbas Z, Mumtaz K, Salam A, Jafri W. Factors predicting
Hyperkalemia in patients with Cirrhosis receiving
Spironolactone J Coll Physicians Surg Pak 2003;13:382–4.
Ginès P, Cárdenas A, Arroyo V, Rodés J. Management of
cirrhosis and ascites. N Engl J Med 2004;350:1646–54.
Abu Noem Faruqui, Layeeq Ahmed S. Total Abdominal
Paracentesis in Cirrhotic Patients with Ascites with in Albumin
or Polygeline. Ann Abbasi Shaheed Hosp Karachi Med Dent
Pai M, Zacharoulis D, Milicevic MN, Helmy S, Jiao
LR, Levicar N, et al. Autologous Infusion of Expanded
Mobilized Adult Bone Marrow-Derived CD34+ Cells Into
Patients With Alcoholic Liver Cirrhosis, Am J Gastroenterol