Chylous ascites refers to a turbid, milky, or creamy peritoneal fluid due to the presence of thoracic or intestinal lymph. Such a fluid shows Sudan-staining fat globules microscopically and an increased triglyceride content by chemical examination. Opaque milky fluid usually has a triglyceride concentration of mmol/L (1000 mg/dL), but a triglyceride concentration of mmol/L (200 mg/dL) is sufficient for the diagnosis. A turbid fluid due to leukocytes or tumor cells may be confused with chylous fluid (pseudochylous), and it is often helpful to carry out alkalinization and ether extraction of the specimen. Alkali tend to dissolve cellular. | Chapter 044. Abdominal Swelling and Ascites Part 4 Chylous ascites refers to a turbid milky or creamy peritoneal fluid due to the presence of thoracic or intestinal lymph. Such a fluid shows Sudan-staining fat globules microscopically and an increased triglyceride content by chemical examination. Opaque milky fluid usually has a triglyceride concentration of mmol L 1000 mg dL but a triglyceride concentration of mmol L 200 mg dL is sufficient for the diagnosis. A turbid fluid due to leukocytes or tumor cells may be confused with chylous fluid pseudochylous and it is often helpful to carry out alkalinization and ether extraction of the specimen. Alkali tend to dissolve cellular proteins and thereby reduce turbidity ether extraction leads to clearing if the turbidity of the fluid is due to lipid. Chylous ascites is most often the result of lymphatic disruption or obstruction from cirrhosis tumor trauma tuberculosis filariasis Chap. 211 or congenital abnormalities. It may also be seen in the nephrotic syndrome. Rarely ascitic fluid may be mucinous in character suggesting either pseudomyxoma peritonei Chap. 291 or rarely a colloid carcinoma of the stomach or colon with peritoneal implants. On occasion ascites may develop as a seemingly isolated finding in the absence of a clinically evident underlying disease. Then a careful analysis of ascitic fluid may indicate the direction the evaluation should take. A useful framework for the workup starts with an analysis of whether the fluid is classified as a high transudate or low exudate gradient fluid. High-gradient transudative ascites of unclear etiology is most often due to occult cirrhosis right-sided venous hypertension raising hepatic sinusoidal pressure Budd-Chiari syndrome or massive hepatic metastases. Cirrhosis with well-preserved liver function normal albumin resulting in ascites is invariably associated with significant portal hypertension Chap. 301 . Evaluation should include liver function tests and a .
