Chylous ascites

Results from accumulation of lymph in the abdominal cavity due to lymphatic system interruption.

May be caused by: obstruction of the lymph flow by external pressure resulting in leakage from dilated subserosal lymphatics into the peritoneal cavity, exudation of lymph via the walls of retroperitoneal vessels lacking valves into the peritoneal cavity , and from thoracic duct obstruction causing leakage of chyle.

Conditions that cause disruption of the lymphatic vasculature result in leakage of lymph from the lymphatic system into the peritoneal space.

Lymphatic disruption is usually caused by duct damage from abdominal surgery, and non-surgical trauma is a less common cause.

Lymphatic obstruction can occur through either direct blockage of the lymphatics or impaired drainage into the venous system, the latter can be caused by congestive heart failure or portal hypertension due to cirrhosis.

Characterized by the accumulation of proteins rich and chylomicron rich lymphatic fluid in the peritoneal cavity.

Chylous ascites is distinct from other, more common types of ascites that are categorized with the use of the serum-as items albumin gradient (SAAG).

SAAG associated with the high SAAG is often seen with portal hypertension due to cirrhosis but can be seen with heart failure.

Ascites associated with a low serum to albumin gradient is typical of inflammatory states.

Associated with more than 40 etiologoes, but is typically seen in less than 1% of patients with cirrhosis.

Causes include trauma, lymphoma, cirrhosis, tuberculosis, and malignancies.

Most common cause is abdominal malignancies, especially lymphoma which accounts for one third of cases, and cirrhosis.

Lymph is generated from fluid squeezed out of the vasculature, filtered through the tissues and collected in lymphatic ducts.

In the G.I. mucosa of the small intestine this fluid contains chylomicrons, the primary mechanism for transporting long chain fatty acids from digested food, and its presence gives git lymphatic fluid a milky white appearance which can be observed in chylous ascites.

Portal hypertension is a frequent cause of chylous ascites that is not related to lymphatic injury.

In a small number of patients with cirrhosis, chylous ascites develops.

Concentration of triglycerides in fluid is greater than 200 mg/dL.

Incidence increasing and estimated to be 1 per 20,000 hospital admissions.

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