Cytological abnormalities in ascitic fluids and their association with age and gender as seen in Pathology Department- Makerere University College of Health Sciences

Abstract

ABSTRACT Background The prevalence of ascites by estimation is approximately 75,000 per 100,000 individuals with cirrhosis in Western countries (Pedersen et al., 2015), with a vast distribution of etiology related to the prevalence of the underlying diseases. The prevalence of cirrhosis, malignancy, heart failure, tuberculosis, and nephrotic syndrome is approximately 81,000, 10,000, 3,000, 2,000, and 1,000 per 100,000 individuals with ascites worldwide, respectively(BA et al., 1992). Ascitic fluid may accumulate rapidly or gradually depending upon the cause. Mild ascites may not produce any symptoms. Moderate ascites may just produce an increase in abdominal girth and weight gain. Large amounts of fluid can produce abdominal discomfort, appearance of hernias particularly umbilical hernias and hinder the mobility of the patient. Elevation of diaphragm and restriction of its movements can produce breathlessness(Sood, 2014). The cytological abnormalities in ascitic fluid can be classified into three major types that is; Acute bacterial peritonitis (or spontaneous bacterial peritonitis), Malignant mesothelioma and Adenocarcinoma. Aim and objectives of the study; To determine the prevalence of cytological abnormalities in ascitic fluids received in Pathology department- Makerere University College of Health Sciences and to establish the association between cytological abnormalities in the ascitic fluid with age and sex. Methodology; This was a retrospective, cross-sectional, laboratory-based study conducted at core reference Pathology laboratory of Makerere University College of Health Sciences Pathology Department in which all records of all ascitic fluid abnormalities diagnosed from January 2014 to December 2018 were retrieved. Results; Out of the 72 cases with ascites, 31 cases were benign, 26 malignant and 15 cases were inflammatory. The mean age at diagnosis was 39.68 years, SD (20.34) at 95% level confidence interval and the mean age range was (20-39) years. The age range 20-39 had the highest prevalence of benign ascites followed by 0-19 and 60-79. The age range 40-59 had the highest prevalence of malignant ascites followed by 20-39. The age range 20-39 had the highest prevalence of inflammatory ascites followed by 40-59 and 60-79. Both male and female cases in the study had a relatively equal prevalence of benign, malignant and inflammatory ascites.

Conclusion Ascites affects both males and females relatively equally. The age range 20-39 was mostly affected with ascites having a percentage of 38.9% followed by age range 40-59 which was second most affected with a percentage of 23.6%.

Recommendations Benign ascitic fluid conditions should be given the first priority by cytologists and thorough follow up should be done to decrease on their likeliness of death from complications of ascites. Sensitization of masses with signs of ascites to seek medical attention as early as possible and the country authorities should also set up cytology units at regional levels or even much more at district levels so that the patients with early signs of ascites can seek medical attention in time and this will also ensure proper and equitable service delivery for every citizen in the country.