What is the reason for ascites in a 33-year-old female?

Question

Hi doctor,

The patient is a 33-year-old female, measuring 5.5 feet in height and weighing 132 lbs, who presented with abdominal pain. Clinical evaluation revealed ascites, which was partially drained, with some residual fluid remaining.

Her medical history is significant for ongoing abdominal pain, pain involving one side of the body, discomfort in the rectal region, and a frequent urge to pass stool without successful bowel movements.

She also reports chest pain, discomfort affecting the left side of her body, and pain in the esophagus, accompanied by a burning sensation. A CT scan of the entire abdomen has been performed for further assessment.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Your main problem is ascites, which are leading towards gastro-esophageal reflux. But the cause of ascites here could not be known. The most typical cause of ascites is cirrhosis (due to alcohol, hepatitis B, and C), but the liver is normal on ultrasound. There are also some other causes of ascites.

We have to do work up for ascites. Please do the following investigation as early as possible and answer a few of my questions.

1. Do you have a history of alcohol intake. If yes, then how much in a week?

2. Since when you have developed this problem?

3. Have you lost any weight in the last six months. If yes, then how much?

4. Do you have any history of viral hepatitis?

5. Do you have any tuberculosis patients in close contact?

6. Do you have any history of pregnancy in recent days?

7. Do you have any history of deep vein thrombosis?

Investigations to be done are

HBsAg (hepatitis B virus surface antigen) by ELISA (Enzyme-linked immunosorbent assay). HBcAb (hepatitis B core antibody). Anti-HCV (hepatitis C virus) by ELISA. Liver biochemical tests. Ascitic fluid routine examination and Cytology). Serum Albumin Ascites Gradient (SAAG). Ascitic fluid adenosine deaminase levels (ADA).

The treatment plan include Capsule Omeprazole 40 mg once daily 30 minutes before breakfast. Syrup Gaviscon (Aluminum hydroxide and Magnesium Carbonate) two tablespoon after meals thrice a day.

If you have any further questions, please do not hesitate to ask.

I wish you a speedy recovery.

Thank you.