Diagnosis of Ascites in Infants and Children

Diagnosis of Ascites in Infants and Children

Ascites is the pathologic accumulation of fluid within the peritoneal cavity. Causes of ascites in infants and children :hepatobiliary disorders,serositis, neoplasm, cardiac, genitourinary disorder, metabolic disease and others.

Diagnosis of ascites :history of abdominal distention, increasing weight, respiratory embarrassement, symptoms and signs of (hepatic ,cardiac,renal disease, tuberculosis and malignancy).

lnvestigation:complete blood count, complete urine examination, liver function tests, plasma proteins, renal function tests, clotting screen, tuberculin test, chest and abdominal plain films,abdominal ultrasound, upper gastrointestinal endoscopy, abdominal paracentesis for ascitic fluid analysis .

Definition : Ascites is the pathologic fluid accumulation within the peritoneal cavity .

causes of ascites in infants and children :

• Hepatobiliary disorders (cirrhosis, congenital hepatic fibrosis, acute hepatitis B,C ,Budd -chiari syndrome, Bile duct perforation)
• Serositis (crohn's disease, eosinophilic enteropathy , Henoch- Shonlein purpura )
• Neoplasm (lymphoma, wilm's tumor ,Glioma, Germ cell tumor, Ovarian tumor,mesothelioma, Neroblastoma )
• Cardiac (Heart failure )
• Metabolic disease
• Gastrointestinal disorder (Nephrotic syndrome, peritoneal dialysis ). Diagnosis of ascites :History of abdominal distention, increasing weight, respiratory embarrassement, jaundice, bleeding (haematemsis, melena, and epistaxis ),Pruritus ,Growth failure ,abdominal pain, fever,Cyanosis, ,dyspnea during suckling, Orthopnea, Buffy eyes, lower limb swelling, Haematrruria .

By examination : Tachycardia ,Tachypnea ,Hypertension ,cyanosis, jaundice, clubbing of fingers ,limb edema ,Hepatomegaly, splenomegaly, dilated abdominal wall veins.

Investigations :

Laboratory tests :complete blood count , complete urine examination, liver function tests, plasma proteins, renal function tests, clotting screen, tuberculin test.

Imaging studies :chest and abdominal plain films, abdominal ultrasound, upper gastrointestinal endoscopy CT, MR I, Abdominal paracentesis for ascitic fluid analysis :cell count / cytology ,Gram 'stain and culture, Total proteins (albumin /globulin ratio ), Glucose, Amylase, lactase dehydrogenase, Triglycerides,Bilirubin.

Serum ascites albumin gradient (SAAG )is the best single test for classification of ascites into portal hypertensive (SAAG >1.1g/dl) and non-portal hypertensive (SAAG <1.1g/dl) causes.

Inclusion Criteria:

• age from 1month to 18 year
• infants and children with ascites (hepatic, cardiac, renal, malignant or tuberculous )
• infants and children with peritonitis

Exclusion Criteria:

• age <1month
• surgical conditions as ruptured viscous or located abscess