title: Role of laparoscopy in the diagnosis of low serum ascites albumin gradient.
abstract: The objective is to determine causes of low serum ascites albumin gradient (SAAG) by direct visualization and obtaining biopsy samples using laparoscopic technique. This is a hospital-based, observational study conducted at Department of Gastroenterology, Sheikh Zayed Hospital, Lahore from January 2001 to April 2002. A total of 33 patients with ascites (SAAG < 1.1 g/dl)) were selected. The findings on history and clinical examination, information from laboratory and radiological investigations were recorded. Laparoscopic findings and histological reporting were correlated. The mean ages were 48.38 +/- 16.7 years. Fifteen (45%) patients were male. The mean duration of the presenting complaints was 3.33 +/- 1.9 months. Ascites was present in all with mean SAAG of 0.73 +/- 0.22. Laparoscopic evaluation showed tuberculous peritonitis in 22 (66.7%) patients and carcinomatous peritonitis in 5 (15.2%) patients. Biopsies were obtained from omentum in 20, peritoneal surface in 5 and liver in 12 patients. The histopathological diagnosis was granulomatous inflammation in 20 (60.6%) and diagnosis of malignancy was made in 7 (21.2%); one (3%) had Budd Chiari Syndrome, 4 (12%) had cirrhosis of liver with super-added Hepatocellular carcinoma and biopsy was non-conclusive in 1 patient. No complication of procedure occurred in this cohort. Laparoscopy is a safe diagnostic modality to establish the cause of low SAAG ascites.
authors.affiliation: Department of Gastroenterology, Sheikh Zayed Hospital Complex, F.P.G.M.I, Lahore.
authors.forename: Nasir Hassan
authors.initials: NH
authors.lastname: Luck
authors.forename: Anwaar A
authors.initials: AA
authors.lastname: Khan
authors.forename: Altaf
authors.initials: A
authors.lastname: Alam
authors.forename: Arshad Kamal
authors.initials: AK
authors.lastname: Butt
authors.forename: Farzana
authors.initials: F
authors.lastname: Shafquat
mesh_terms: D001201:Ascites / Q000175:diagnosis*; D001202:Ascitic Fluid / Q000737:chemistry*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000175:diagnosis; D014395:Peritonitis, Tuberculous / Q000175:diagnosis; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D015415:Biomarkers; D012709:Serum Albumin