Question of the Week

Question :
Posted On : 09 Feb 2018
respected sir,
i work as a pediatrics esident in a small hospital, india.
i have a patient who is 7 months old, well till 10 days ago.
to start with he had abdominal distention and pale colored stools for 10 days. there was no fever or any other complaints. in the ward he developed hematuria.
his reports are usg - massive ascites, hapatitis.
serum bilirubin total - 5, direct - 3
sgpt - 40. alk.phos - 340. pt- inr = 11.3.serum albumin-3.1
torch- negative, Tsh - normal.
ascitic fluid tap was yellow but total count was 800 - lymphocytic. SAAG - 1.8
this place is not equiped with higher investigations and the patient can not afford outside treatment.
kindly guide us in the probable diagnosis and simple investigations to reach that diagnosis.
thanking you sir
Expert Answer :
i will need some further info if i am going tobe of any help
Is the INR really 11.3
Is the albumin- 3.1- is this supported with 20 percent albumin. If not it is unusual to see massive ascites with such ana Albumin level
Is there any family history of TB.
I am aware that in TB SAAG is Less than 1.1. However if your serum Albumin measurement is not accurate, the value of SAAg may change. Looking forward to your answer
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