Question

A patient with a history of chronic liver disease presents with abdominal distension, jaundice, and pruritis. Ascitic fluid analysis revealed a neutrophil count >650 per cubic mm. What is the most likely diagnosis?

• A. Spontaneous bacterial peritonitis
• B. Malignant ascites
• C. Tubercular ascites
• D. Intestinal obstruction

Answer 1

The Correct Option is A

To determine the most likely diagnosis for this patient, we should consider the clinical presentation and the ascitic fluid analysis.

1. The patient has chronic liver disease, which often leads to complications such as ascites due to portal hypertension.

2. The presence of abdominal distension, jaundice, and pruritus are indicative of liver dysfunction and potential complications in patients with cirrhosis or liver failure.

3. The ascitic fluid analysis revealed a neutrophil count >650 per cubic mm. This is a critical diagnostic criterion. In clinical practice, a neutrophil count >250 cells per cubic mm in ascitic fluid is already suggestive of spontaneous bacterial peritonitis (SBP).

Given these clinical findings:

• Spontaneous bacterial peritonitis (SBP) is characterized by a high neutrophil count in the ascitic fluid, especially >250 cells per cubic mm, in patients with cirrhosis and ascites.
• SBP is a common and serious complication of cirrhosis, which fits the patient's history and current findings.
• The other options such as malignant ascites, tubercular ascites, and intestinal obstruction, have different clinical markers. Malignant ascites typically shows cancer cells in fluid; tubercular ascites is associated with a lymphocyte-predominant profile; intestinal obstruction does not typically present with ascitic fluid with high neutrophil counts.

Therefore, the most likely diagnosis based on the ascitic fluid neutrophil count and the patient's chronic liver disease history is Spontaneous bacterial peritonitis.