Aetiological considerations in 96 consecutive cases of ascites

Abstract

Background: Ascites is always a feature of an underlying disease, whose cause is unknown at presentation most of the time. Its initial treatment therefore will be empirical and dependent on the most frequent and common causes in the environment.
Aim: To evaluate a cohort of patients with ascites to determine the common causes in in the University of Port Harcourt Teaching Hospital (UPTH).
Methods: We undertook a clinical evaluation of 96 consecutive cases seen at the UPTH, over a three-year period, using a combination of diagnostic modalities which included biochemical, serological and cytological examination of the ascitic fluid, as well as radiology and ultrasonography, and histological examinations of liver biopsy specimens in cases suggestive of liver disease.
Results: The three most common causes of ascites in this series were liver diseases-36.5% (chronic liver disease 27.1%, hepatocellular carcinoma 9.4%), renal diseases 30.2% (chronic renal failure 23.9%, nephrotic syndrome 6.3%), and cardiac diseases 23.9% (congestive cardiac failure 22.9%, Endomyocardial fibrosis 1%). The clinical conditions associated with portal hypertension (liver and cardiac diseases) accounted for 60% of cases. Localized intra-abdominal disease, such as tuberculosis was rare (3.1%), and chronic alcohol consumption was very common amongst all aetiological groups. Peripheral oedema was a frequent accompaniment of the renal and cardiac cases more than the liver diseases, whereas pleural effusion was very rare.
Conclusion: Patients presenting with ascites can be commenced on diuretics and salt restriction pending the establishment of a definitive diagnosis.


Port Harcourt Medical Journal Vol. 1(1) September 2006: 29-33