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