Known cases of C.L.D with Ascites present with abdominal pain and tenderness. Ascitic tap shows presence of 60 PMN cells/Cu.mm. Which of the following is the likely etiology?
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- Tubercular Ascites
- Malignant Ascites
- Spontaneous Bacterial peritonitis
- Chylous ascites
The Correct Option is C
Solution and Explanation
To solve this question, we need to identify the most likely etiology of ascites with the presence of 60 polymorphonuclear (PMN) cells per cubic millimeter (cu.mm) in the ascitic fluid. The key to answering this question lies in understanding the typical characteristics of different types of ascites:
- Tubercular Ascites: Tubercular ascites usually presents with high protein content in the ascitic fluid and a lymphocyte predominance (not PMNs). The PMN cell count in tubercular ascites is typically lower than bacterial peritonitis.
- Malignant Ascites: Malignant ascites generally shows a high total cell count with lymphocyte predominance, and may contain cancer cells. The PMN count is usually not elevated.
- Spontaneous Bacterial Peritonitis (SBP): This condition is characterized by an elevated PMN cell count, typically >250 cells/cu.mm, in the ascitic fluid. Although the given PMN count is 60 cells/cu.mm, this condition is still more consistent with SBP compared to other options, given the context of abdominal pain and tenderness in Chronic Liver Disease (CLD) patients.
- Chylous Ascites: Chylous ascites is characteristically milky due to a high triglyceride content and is associated with lymphatic obstruction. It usually does not have elevated PMN cells.
Given these explanations, Spontaneous Bacterial Peritonitis (SBP) is the most consistent with the scenario. Although the PMN count is below the typical threshold used to diagnose SBP (>250/cu.mm), cases of early SBP can present with a lower count, especially if the sample is obtained early in the infection.
Therefore, based on the signs of CLD, abdominal symptoms, and the presence of PMNs, the most likely etiology of the provided scenario is Spontaneous Bacterial Peritonitis.
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