Etiologi of malignant ascites

Malignant ascites is a sign of peritoneal carcinomatosis, the presence of malignant cells in the peritoneal cavity. Tumors causing carcinomatosis are more commonly secondary peritoneal surface malignancies which include: ovarian, colorectal, pancreatic and uterine; extra-abdominal tumors originating from lymphoma, lung and breast; and a small number of unknown primary tumors. Malignant ascites accounts for approximately 10% of all cases of ascites (Suma and Thomas, 2012).

Classification The old classification of exudative versus transudative ascites has been updated

through the use of the serum-ascites albumin gradient (SAAG).

SAAG = (the serum albumin concentration) – (ascitic fluid albumin concentration).

A SAAG > 1.1 g/dl indicates ascites due to, at least in part, increased portal pressures, with an

accuracy of 97%. This is most commonly seen in patients with cirrhosis, hepatic congestion, CHF, or

portal vein thrombosis.

A SAAG < 1.1 g/dl indicates no portal hypertension, with an accuracy of 97%; most commonly seen in

peritoneal carcinomatosis, an infectious process of the peritoneum, nephrotic syndrome, or

malnutrition/hypoalbuminemia(http://www.eperc.mcw.edu).

If untreated, mono- sodium urate may deposit in cartilage, tendons, bursae, soft tissue and synovium in deposits called tophi. These are commonly found in olecranon bursae, Achilles’ tendon, around joints and ear. May extrude white pasty material and can limit joint mobility. persistent gout chronic tophaceous gout produces tophi, solid deposits of of monosodium urate crystals