• Mumtaz Ali Shaikh
  • Jehangir Khan
  • Suhail Almani
  • Dur -e- Yakta
  • Dargahi Shaikh


Background: 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

Gastroenterol 2006;101(Suppl):1:S1–6.

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

Pak 2008;18:404–7.

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

Abottabad 2007;19(3):22–4.

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

Assoc 2007;57(1):33–4.

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.

Gastroenterology 2002;122:923–30.

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.

Hepatology 2002;35:140–8.

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

Coll 2002;7:396–8.

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