Biochemical studies of the ascitic fluid in hepatic cirrhosis.

Abstract

scITic FLVlD appears frequently in the course of cirrhosis of the liver. Th is complicat ion is generally considered to be present in 50-80 per cent of cases of cirrhosis and is found most often in cirrhosis of the "at rophic type." Numerous etiologic factors have been suggested to explain the pathogenesis of ascites in cirrhotic patients. T h e principal ones are felt to be: portal hypertension, 1 hypoa lbuminemia , 2 alterations of electrolyte metabolism (secondary hyperaldosteronism),.~ alterations in the metabol ism of ant idiuret ic hormone, 4 and obstruction of lymphat ic flow. ~ Each of these factors may play a par t in the product ion of ascites, but it is not possible, in practice, to conclude which is the principal one. Biochemical studies of the ascitic fluid of cirrhotic subjects demonstrate it to be poor in proteins and to behave like a transudate. 6, 7 In comparative electrophoretic studies of serum and ascitic fluid in patients with hepatic cirrhosis, it has been found that the protein fractions of each are alike qualitatively. 8, 9 A recent paper 1° has emphasized the quant i ta t ive relationships between the protein fractions of ascitic fluid and those of serum. These relationships may be helpful in distinguishing between the various types of ascites. Unti l recently most studies have been concerned with these prote in relationships; however, few workers have studied other components of ascitic fluid. 11, 12 In the investigation to be described in this article, we studied protein, bi l irubin, inorganic phosphorus, and alkaline phosphatase in ascitic fluid in cirrhotic patients and a t tempted to establish a correlation between them and their respective serum values, hoping thereby to obtain a bet ter unders tanding of the nature of the ascitic fluid formed.