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Bile constituents in ascitic fluid.
G Hedenborg1, G Jönsson, A Norman
1Department of Clinical Chemistry, Karolinska Hospital, Stockholm, Sweden.
Scandinavian Journal of Clinical and Laboratory Investigation
|October 1, 1988
Summary
Bile acids and bilirubin accumulate in cirrhotic ascites, forming a significant abdominal pool. Malignant ascites shows distinct lower bile acid and higher albumin levels, highlighting disease-specific differences in fluid composition.
Area of Science:
- Hepatology and Gastroenterology
- Biochemistry
- Clinical Medicine
Background:
- Ascites is a common complication of liver cirrhosis and malignancy.
- The composition of ascites fluid can provide insights into the underlying disease process.
- Bile acids and other bile constituents are important indicators of liver function.
Purpose of the Study:
- To compare the levels of bile acids and other bile constituents in ascites fluid from patients with liver cirrhosis versus malignancy.
- To investigate the correlation between serum and ascites levels of these constituents.
- To understand the implications of ascites composition on bile acid turnover in liver cirrhosis.
Main Methods:
- Serum and ascites samples were collected from patients with liver cirrhosis and malignant ascites.
- Levels of bile acids (cholic acid, chenodeoxycholic acid, and their conjugates), bilirubin (unconjugated and conjugated), albumin, cholesterol, phospholipids, and immunoglobulins (IgG, IgA, IgM) were measured.
- Ascites to serum ratios were calculated for various constituents.
Main Results:
- In cirrhotic ascites, total bile acid levels were 53% of serum levels, with strong correlations for cholic and chenodeoxycholic acid.
- Cholic acid showed a higher ascites to serum ratio than chenodeoxycholic acid.
- Bilirubin levels in cirrhotic ascites averaged 24% of serum values, with variable conjugate occurrence. Albumin and other proteins, cholesterol, and phospholipids were lower than in serum.
- Malignant ascites had significantly lower bile acid levels compared to cirrhotic ascites, but higher albumin and cholesterol levels, with no overlap between groups.
Conclusions:
- High bile acid levels in cirrhotic ascites indicate a substantial abdominal bile acid pool, impacting turnover studies.
- Ascites fluid composition varies significantly between liver cirrhosis and malignancy.
- Disease-specific mechanisms of ascites formation lead to distinct levels of bile constituents in ascitic fluid.