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 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 60of 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