Abdominal Dropsy (Ascites): Test and Diagnosis

1st order laboratory parameters-obligatory laboratory tests-.

  • Small blood count
  • Differential blood count
  • Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
  • Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH), gamma-glutamyl transferase (γ-GT, gamma-GT; GGT), alkaline phosphatase, bilirubin.
  • Amylase
  • Albumin in serum (important protein/protein).
  • Total protein in serum
  • Renal parameters – creatinine, urea.
  • Ascites puncture with bacteriological, cytological examination, determination of protein content, specific gravity and determination of serum/ascites albumin quotient – differentiation of malignant/malignant (from benign/benign) and infected (from non-infected) ascites.

Examination of the ascites punctate including differential diagnosis.

Laboratory parameters Transsudate Exudate
Protein content <30 g/l > 30 g/l
Specific gravity <1.106 g/l > 1.106 g/l
Serum/ascites albumin quotient (SAAG). > 1.1 (= portal-hypertensive ascites). < 1.1 (= non-portal-hypertensive ascites)
Differential diagnosis
  • Hypalbuminous ascites:
    • Malnutrition
    • Hypalbuminemia (decreased albumin (protein) concentration in the blood).
    • Hypothyroidism (underactive thyroid gland)
    • Nephrotic syndrome
  • Cardiac (“heart-related”) ascites* :
    • Heart failure (cardiac insufficiency).
    • Valvular heart disease,
    • Constrictive pericarditis (“armored heart“).
  • Portal ascites* :
    • Liver cirrhosis
    • Budd-Chiari syndrome (thrombotic occlusion of the hepatic veins),
    • Pford vein thrombosis

* Determination of total protein (GE) allows differentiation between cardiac (GE > 2.5 g/dl) and portal hypertensive (GE < 2.5 g/dl) genesis (origin).

  • Inflammatory ascites: Leukocytes ↑ (pyogenic peritonitis/superficial peritonitis; >250 granulocytes/mm3 define spontaneous bacterial peritonitis, SBP); if infected ascites is suspected, microbiological culturing to detect the causative agent (e.g., tuberculous peritonitis; spontaneous bacterial peritonitis, SBP: mainly gram-negative bacteria, for example, E. coli).
  • Malignant (“malignant”) ascites:
    • CUP syndrome: Cancer of Unknown Primary (English): cancer with unknown primary tumor (in approximately 20% of cases with malignant ascites/malignant ascites, the primary tumor remains unknown).
    • Bronchial carcinoma (lung cancer).
    • Endometrial carcinoma
    • (cancer of the uterus)
    • Gastrointestinal tumors (gastrointestinal tumors).
    • Hepatocellular carcinoma (HCC; hepatocellular carcinoma/liver cell cancer).
    • Colon carcinoma (colon cancer)
    • Liver metastases
    • Malignant lymphoma (malignant neoplasm originating from lymphoid cells).
    • Gastric carcinoma
    • Mammary carcinoma (breast cancer)
    • Ovarian carcinoma (ovarian cancer)
    • Pancreatic carcinoma (pancreatic cancer)
    • Peritoneal carcinomatosis – diffuse metastases (daughter tumors) in the peritoneum (peritoneum).
    • Pseudomyxoma peritonei (biliary abdomen)[amylase and lipase ↑]

For more information, see “Examination of an ascites punctate“.