Is it Tubercular ascites?

45 year old male presented to OPD with complaints of breathlessness, weakness, decreased appetite and abdominal enlargement History Patient is a known alcoholic Physical Examination Fluid Thrill and shifting dullness present 20ml Ascitic fluid tapping done for analysis Investigations USG suggests liver enlargement with Ascites too HBsAg, Anti HCV, LFTs, CBC,are awaited Ascitic fluid for ADA is awaited Management Your opinion on the ascitic fluid report? Since lymphocytes are on the higher side,is it suggestive of Tubercular ascites?

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Wait for reports and be conclusive. Needs further investigation and evaluation to conclude and liver enlargement and it's function. BS antibiotics iv bd. Stop alcohol by reassurance and councelling required. Iv fluids to balance electrolytes and multivitamin. Reassess general health and evaluation to go for ascites drain step by step. Start ATT and symptomatic treatment. Good neutrinos balance diet.

Thanks Dr Pushkar Bhomia
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Reports of your ordered investigation would give a clue to DD .. You are managing the case in a best possible manner Dr.Ajitji.

Yesssssssss dr u r ryt We can presume as Provisional Diagnosis-Tuberculous ascitic fluid. Due to predominance of lymphocytic infiltration. Just need to find focus of primary infection. Can consider as one of D/D..

Thanks for ur appreciation Dr Anjali Mam..
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Could be Tuberculosis. ADA Sr LDH Sr protein pleural fluid protein level Would be conclusive.

Low proteins may be because of hypoprotenemia lymphocytes tubercular

To confirm Tuberculosis do the following Ascetic fluid for Afb ADA Xene expert for kochs Also rule out CLD

Chances of traumatic tapping DD Malignancy Tb Cirrhotic liver effect Cbnat Adacell Malignant cell

Suggested.. Ascitic fluid fir cbnaat

It’s border line get other investigations

Not to look on lymphocyte count , Neutrophils are initial count always to be replaced by Lymphocytes . Surely it’s not SBP . It should be transudative fluid.

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