Abdominal fluid accumulation
Abdominal fluid accumulation indicates the onset of a medical condition called ascites. Ascetic fluid is a pale yellow colored fluid. The predominant accumulation of ascetic fluid occurs in the region of peritoneum. Ascetic fluid has many sources. However the most significant source is the liver. One of the major causes for ascites is liver cirrhosis.
Causes for accumulation of ascetic fluid
The factors contributing to liver cirrhosis are associated with portal hypertension and edema caused because of tissue fluid imbalance or infection. The formation of ascetic fluid is also associated with the decrease in albumin levels. Albumin levels are decreased in portal hypertension conditions. Another significant factor that leads to accumulation of ascetic or abdominal fluid is the underlying condition of kidney failure caused due to excess salt and water retention. In addition, ascetic fluid accumulation is also caused because of underlying conditions such as neoplasm, congestive heart failure and infectious diseases such as tuberculosis. Ascetic conditions are classified into transudative and exudative types based on the protein estimation of the respective ascetic fluid. The comparative analysis of protein in the ascetic fluid is based on the albumin levels in the ascetic fluid when compared to serum albumin. This comparative analysis is also called as serum ascites albumin gradient.
Symptoms of abdominal fluid accumulation
Ascetic symptoms are associated with abdominal pain and discomfort. In some cases the ascetic condition is initially asymptomatic which progresses into a symptomatic condition. Shortness of breath occurs because of pleural effusion which is caused by the pressure on diaphragm because of the abdominal fluid rise. Apart from these other symptoms are nausea, anorexia, and bloating and flank pain.
Conditions associated with abdominal fluid accumulation such as ascites are diagnosed using laboratory analysis. Laboratory tests such as ascetic fluid protein estimation, albumin analysis, amylase, lactose dehydrogenase and triglyceride values are taken into consideration. These values help in the determination of underlying conditions which may be responsible for the accumulation of ascetic fluid in the abdominal cavity.
Microbiological analysis such as Gram's stain, acid fast stain and also cultures of both routine bacteriology and for Mycobacterium is done to diagnose the condition due to of infectious diseases. In the case of tuberculosis, the ascetic fluid tends to appear chylous or milky in nature. This because of the presence of thoracic or interstitial fluid. The serum ascites albumin gradient values are taken into consideration to determine the cause of ascites because of bacterial peritonitis, Pancreatitis, Vasculitis and portal hypertension. High albumin gradients or transudative gradients generally occur in unclear etiologies such as occult cirrhosis and portal hypertension. Hepatic vein thrombosis and liver cirrhosis related ascites is generally diagnosed by biopsy and radiological methods.
Treatment of abdominal fluid accumulation
Ascites is treated according to fluid electrolyte monitoring. The patient is prescribed a restricted salt diet in order to avoid edema. In cases of low sodium levels, the salt restriction may be increased to 1.5 l instead of 1. Diuretics are generally prescribed in the case of ascites. The research pertaining to the use of aquaretics for the excretion of electrolyte free water is still underway for the approval.
Therapeutic paracentesis is administered on a regular basis to treat refractive ascites. The most effective method for reducing the portal pressure in patients with ascites and under diuretics is the administration of trans jugular intrahepatic portosystemic shunt also known as TIPS. This is a radiological procedure used in patients suffering from refractive ascites; this technique may be performed either in conscious state or by administering general anesthesia.
Abnormal liver enzyme
Abnormal liver enzyme detection and estimation provides a comprehensive foundation for the identification of inflammatory diseases associated with the liver. These values are raised when liver cells are damaged. Routine liver function test helps in the estimation and detection of abnormal liver enzymes.
In many cases liver enzyme abnormalities are caused because of hepatocellular injury. This condition results when the liver cells are damaged producing leaky membranes. The intracellular enzymes enter the blood stream as a result of these leaky membranes. The predominant intracellular liver enzymes which are analyzed indicating the hepatocellular damage are aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Hepatitis is one of major causes for the hepatocellular damage.
Cholestasis is another condition, resulting in the production of abnormal liver enzymes. It is caused because of biliary obstruction or hepatic infiltration. The resulting enzymes produced because of these conditions include alkaline phosphatase (ALT) and gamma glutamyl transpeptidase (GGT).
Risk factors due to abnormal liver enzymes
The risk factors pertaining to the onset of liver disease are based upon factors such as behavior, medications and systemic illness. The patients categorized based on the behavior include IV drug users, history of multiple sex partners, alcohol abuse and tattoos. The patients categorized based on the medication include acetaminophen and anticonvulsant drug users. Systemic conditions such as diabetes, auto immune diseases, obesity and metastatic cancers are major risk factor indicatives of hepatocellular damage which elevate the abnormal liver enzyme values.
Liver function test
Alanine aminotransferase (ALT): It is also known as serum glutamic pyruvic transaminase (SGPT) analysis. It helps in the detection of hepatocellular damage due underlying conditions such as hepatitis. The reference range for the ALT test is 9 -72 u/l.
Alkaline phosphatase (ALP): This test used in the detection of biliary obstruction in liver and also bone disorders. The results are correlated with other liver function tests to diagnose liver cell damage. The reference range is 38-126 u/l
Aspartate aminotransferase (AST): AST is also used in the detection of liver cell damage and membrane leakage of the liver cells. The reference range is 8- 50 u/l.
Bilirubin: Bilirubin diagnostic test is administered to detect conditions such as cirrhosis, hepatitis and presence of gall stones. It is predominantly ordered in the case of newborns to detect the incidence of jaundice. The reference range for total bilirubin is 0.2-1.3 mg/dl.
Albumin: Albumin test signifies the presence of liver disorder or nephrotic syndrome. Low albumin levels indicate the presence of liver damage. The reference range is 3.9- 5.0 g/dl.
Lactate dehydrogenase (LDH): LDH values indicate the presence of tissue damage. It is used to detect tissue damage associated liver, kidney and cardiac origins. The reference range for LDH is 313-618 u/l.
Comprehensive metabolic panel (CMP): Comprehensive metabolic panel pertaining to liver disease is very significant in the detection of underlying liver disorders such as hepatitis especially in newborns. It also helps in the identification of liver damage caused because of alcohol consumption.
Gamma glutamyl transferase (GGT): This test acts as a precursor for the estimation of alkaline phosphatase values pertaining to hepatocellular damage and biliary obstruction. GGT and ALP tests are interrelated in case of hepatic and bone disorders.
Total protein: Total protein levels are measured by evaluating the albumin and globulin ratios. The reference range for total protein is 6.3- 8.2 g/dl. The decrease in total protein value indicates the onset of liver or kidney disease.
Urinalysis refers to a group of tests conducted on urine sample to determine the various chemical components of the urine. Urine analysis is an examination of the urine sample that gives useful information regarding the renal and metabolic disorders, kidney or urinary tract infections, diabetes and host of other diseases. Urinalysis does not diagnose the disease itself, rather the presence of abnormal substances in the urine that will help direct the course of further evaluation and diagnosis. Depending upon the symptoms reported, urinalysis is conducted in three different phases.
1. Visual analysis or physical examination
2. Chemical analysis
3. Microscopic analysis
Physical examination of urine
Color: Normally urine looks pale yellow; any change in the color of the urine indicates some abnormality, for example dark yellow urine indicates dehydration whereas bile pigments cause brown urine. Urine turns red when there is blood in the urine. Sometimes consumption of certain foods such as blackberries, rhubarb and beets turns the urine red.
Clarity: Normal urine is usually clear, cloudy urine indicates the presence of bacteria, blood, sperm, crystals, or mucus. Odor: Normal urine has a nutty odor to it whereas diabetes gives urine a fruity odor and bacterial infections lead to bad odor of the urine.
Chemical analysis of urine
Chemical examination is normally conducted with the help of the dipstick. The change in the colors of the different pads on the dipstick indicates varied health conditions.
pH balance: pH balance measures the acidic and alkaline balance of the urine. The lower or higher pH indicates kidney disorders. pH balance can be changed by consuming the appropriate diet.
Protein: Protein test normally involves examining the albumin levels in the urine. The elevated albumin level is the initial symptom of kidney disorder.
Glucose: Higher glucose levels in the urine is associated with diabetes and other conditions like hormonal disorders, liver disease and pregnancy.
Ketones: When the body does not get enough carbohydrates, it starts metabolizing the fats to gather energy and in process releases ketones into the urine, thus indicating the low levels of insulin.
Blood: Urine is also tested for the presence of red blood cells. Various kidney and urinary tract diseases and trauma, injury, medications, smoking, or strenuous exercise lead to the contamination of urine with the blood.
Nitrites: UTI or urinary tract infection changes the urinary nitrates into nitrites. Therefore the presence of nitrites indicates the presence of UTI. Likewise urine is also tested for Leukocytes as they too indicate the presence of UTI.
Microscopic urine analysis
This test involves collection of urine in centrifuge to be spun for few minutes, so that sediments settle at the bottom. The sediment substance is then spread on the slide and examined under microscope. The urine is tested for the following:
If the urine shows red or white blood cells, it signals an inflammation, kidney disease or an injury of the ureters, bladder, or urethra. Microscopic examination of urine also reveals the presence of crystals. Large number of Crystals in the urine indicates dehydration, pH imbalance, UTI or a condition called Urolithiasis, signifying kidney stone or bladder stones. Urine is also tested for bacteria, yeast cells, or parasites, as any of these organisms in the urine signals infection. Increased quantity of epithelial cells in urine could indicate some health problems.
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Bibliography / Reference
Collection of Pages - Last revised Date: December 1, 2022