Study of Cholesterol Levels in Ascitic Fluid to Differentiate Malignant from Non-Malignant Effusion.

ABSTRACT

Collection of more than normal quantity fluid in a serous cavity is called effusion. Itis classified as per location i.e. pericardial, pleural and peritoneal. Fluid collection inabdominal cavity is called ascites. Effusions are of two types - (1) Transudate (2)Exudate. Transudate develops as a result of physiological disturbances of circulationusually a rise in venous pressure or decrease in oncotic pressure, while exudateforms as a result of increased capillary permeability which is usually due toinflammation. Transudates usually have low specific gravity due to low proteincontent whereas exudates have high specific gravity due to high protein content.Transudates are usually associated with cardiac-, hepatic- or renal-disease. Whileexudates are caused by inflammatory conditions like tuberculosis and malignanciesof pelvic and abdominal organs. Recently fibronectin and cholesterol levels ofperitoneal fluid have been found to differentiate between ascites of differentaetiologies. The estimation of fibronectin levels in fluid is sensitive but complicated.So, in this study we have taken the value of cholesterol for the aetiologic diagnosisof ascites as a simple procedure.METHODSThe present descriptive study of 100 cases of ascites was conducted over a period of12 months i.e. January. 2019 to January 2020. Various fluids were collected fromOPD and IPD of Medical and Surgery units.RESULTSIn the present study, 84% of the cases were transudates while exudates accountedfor 16% of cases. Cirrhosis (65%) was the commonest cause among transudates.Other causes included congestive cardiac failure (09%), nephrotic syndrome (06%),& anaemias (04%). Exudative ascites was caused by tuberculosis in 10% cases &malignancy in 06% cases. Cholesterol level of >70 mg/dL was found in 82% ofmalignant ascites. So, it was concluded that ascitic fluid cholesterol levels weresignificantly greater in malignant cases in comparison to ascites caused by non -malignant aetiologies. Inference - Cholesterol concentration in ascitic fluid helps todifferentiate ascites in malignancy, from non - malignant ascites.CONCLUSIONSCholesterol estimation in ascitic fluid is a better parameter to differentiatemalignant ascites from non - malignant ascites.