Known cases of C.L.D with Ascites present with abdominal pain and
tenderness. Ascitic tap shows presence of 60 PMN cells/ICu.mm. Which of the following
is the likely etiology?
A. Tubercular Ascites
B. Malignant Ascites
C. Spontaneous Bacterial peritonitis
D. Chylous ascites
Answer. C
Solution. The presence of a high number of PMN cells (polymorphonuclear leukocytes) in an
ascitic tap suggests the presence of inflammation, which is most commonly due to a bacterial
infection. In this case, the likely etiology would be spontaneous bacterial peritonitis (SBP). SBP
is a common and serious complication of cirrhosis, leading to bacterial infection of the ascitic
fluid. Symptoms may include abdominal pain and tenderness, as well as fever and nausea.
Tubercular ascites is caused by tuberculosis, which typically presents with low numbers of PMN
cells and elevated lymphocytes in the ascitic fluid. Malignant ascites is associated with the
spread of cancer to the peritoneal cavity, while chylous ascites is a rare type of ascites caused
by lymphatic obstruction. Both of these conditions would typically present with fewer PMN cells
in the ascitic fluid compared to SBP.