PakMediNet Discussion Forum : Medicine : Young Patient with unexplained Ascites
Young Patient with unexplained Ascites
A 12 years old young patient came with 2 year history of increasing abdominal distention, extensively worked up without any proper clue. She had B/L renal cysts on ultrasound abdomen, with normal liver, portal vein, and no splenomegaly. Renal cysts were later on investigated, biopsied and found to be benign and Renal scan was normal. CT Scan abdomen was also normal except ascites with no evidence of lymphadenopathy, liver disease or splenomegaly. Doppler studies of portal vein, hepatic vein and splenic veins were normal. Ascitic tap was always transudative with cells of 100/cmm, and proteins of 1gm. Serum total proteins were normal. Patient looked smaller then her age, but mentally normal. She had a mentally retarted twin sister. She was also given a course of ATT for 8 months, with the suspicion of abdominal tuberculosis although no other symptoms of chronic disease were there. Despite this treatment, her ascites never settled.
What could be the causes of this unexplained ascites ? What tests would be required to investigate further ? Should we go for peritoneal biopsy, heptospleno arteriography ?
Posted by: docosamaPosts: 333 :: 06-03-2002 :: | Reply to this Message
Re: Young Patient with unexplained Ascites
1. Does hypothyroidism run in this family and was this child tested?
2. Was the ascitic fluid milky after high fat diet.
3. Any history of trauma to the abdomen?
Laparotomy may be indicated to search for the site of leakage of lymph from the intra-abdominal portion of the thoracic duct.
[Edited by chameed on 03-31-2002 at 07:23 PM GMT]
Posted by: chameedPosts: 173 :: 31-03-2002 :: | Reply to this Message
Re: Young Patient with unexplained Ascites
Child has normal thyroid function, and ascitic fluid when tapped is always transudative. There is no history of trauma.
How can you say for laparotomy when the abdomen is full of ascites ?
Posted by: docosamaPosts: 333 :: 02-04-2002 :: | Reply to this Message
Re: Young Patient with unexplained AscitesAscites is not a contraindication for laparotomy. I operate on ovarian cancer all the time with abdomen full of ascites. Surgery has to go in and look at the thoracic duct, ovaries and palpate the area of porta and at the same time do a peritoneal biopsy if necessary.
Posted by: chameedPosts: 173 :: 02-04-2002 :: | Reply to this Message
Re: Young Patient with unexplained Ascites
what is transudative ascites?
you classify ascites as high or low SAAG.
further more did u look at her ovaries.
what about her cardiac status.
what disease does her sister has?
Posted by: kareemPosts: 2 :: 29-09-2004 :: | Reply to this Message
Re: Re: Young Patient with unexplained Asciteshave u send ascitic fluid for cytological examination
Posted by: sarfrazPosts: 3 :: 23-09-2006 :: | Reply to this Message
Re: Young Patient with unexplained Ascites
I think the answer here may be a laproscopic peritoneal biopsy.
Peritoneal Mesothelioma is not un common and is underdiagnosed in many areas.
Posted by: iaansariPosts: 3 :: 27-06-2007 :: | Reply to this Message