Three year old with enlarged liver

Dear Ask The Doctor: What can cause ascites? he is swollen to a stomach size of 70cm. we have ruled out obstuction, hepatitis a,b,c ,dengue, leptospirosis, TB. No cultures or parasites have been found in blood or fluid. we are stomped as to what is causing this and nothing seems to help an answer would be greatly appreciated.

Dear Shiva:

I understand how concerned you are about your son’s condition. Ascites is defined as an abnormal amount of intraperitoneal fluid that may consist of transudates (thin, low protein count, and low specific gravity) or exudates (high protein count and specific gravity). The etiology of ascites may differ among neonates and older children.

Trauma, infection, hepatocellular disease, pancreatic ascites, gynecologic or GI abnormalities, neoplasia, and other miscellaneous causes predominate in children.  Other causes vary in incidence by age and geography. After the newborn period, infections such as tuberculosis are more frequent in underdeveloped areas, whereas hepatobiliary disease and neoplasia are more common in developed countries.

Usually the best to investigate about the cause of the ascites is by taking a sample of the fluid and examining it for the presence of proteins and pathogens that could guide the doctors for the etiology. I would suggest you to consider the possibility of cardiac origin. Cardiac abnormalities (eg, congestive failure, physiologic right-sided heart obstruction, severe valvular regurgitation) may result in ascites. Management is directed at the underlying lesion. I wish him a prompt recovery.