25: Chronic liver disease: ascites
Investigations
- FBC: increased white blood cells (WBCs) indicates an infective cause. Platelets and WBCs may be reduced if there is hypersplenism secondary to chronic liver disease
- LFTs: the results will depend on the cause of the liver disease
- U&E: hyponatraemia is often present
- Ascitic tap: this should be carried out with the first presentation of ascites. The ideal place should be determined by ultrasound scan. The tap may be diagnostic (transudate: high SAAG, low LDH, normal glucose, no WBCs with negative Gram stain and no bacteria cultured; exudate: low SAAG, low glucose, high LDH, raised WBCs and bacteria may be identified). Ascitic and serum amylase may identify pancreatitis as the cause of ascites
- Ultrasound scan: identifies the ascites and may also show Budd–Chiari or veno-occlusive disease. Other features of chronic liver disease may be identified
