الفهرس 
Acknowledgments
Pathophysiology of ascitesOnly 14 pages are availabe for public view
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Abstract
Ascites is of Greek derivation (askites / askhos) which refers to a “bag”, “bladder” or “sack”. The word describes pathologic fluid accumulation within the peritoneal cavity. Ascitic fluid represents a state of total-body sodium and water excess. (Tomar, 2016). Varied pathophysiologic mechanisms lead to the development of ascites. These mechanisms include increased hydrostatic pressure and decreased colloid osmotic pressure within hepatic and splanchnic blood vessels, increased permeability of peritoneal capillaries, and direct leakage of fluid into the peritoneal cavity from different sources of origin. (Cairdenas, et al.,2011) Traditionally ascites is classified into 2 types: transudative and exudative ascites. This classification is based on the amount of protein found in the ascitic fluid. A more useful system has been developed based on the amount of albumin in the ascitic fluid compared to the serum albumin (measured in the blood). This is called Serum Ascites Albumin Gradient (SAAG). (Tomar, 2016). Etiologies for ascites include liver cirrhosis in most of the cases, heart failure, genitourinary disorders , metabolic disorders malignancy , infections ,and other miscellaneous causes in 10 % of cases (Melissa and chris, 2016). Liver cirrhosis is a diffuse process characterized by progressive hepatic fibrosis, distortion of the hepatic architecture and formation of regenerative nodules. chronic cholestasis, inborn errors of metabolism and chronic hepatitis are the main causes of cirrhosis in children. (Giacchino, et al,. 2009). Ascites is a common complication in pediatric cirrhosis, especially in younger children with terminal liver disease. This is generally associated with a poor prognosis.(Pugliese, et al., 2014). In most cases, cirrhotic ascites is resolved through dietary sodium restriction and the use of diuretics. However, children and adolescents ingesting low sodium diet must be carefully monitored, since these restrictions often make the diet unpalatable and reduce food intake. Fluid restriction is strongly recommended in case of hyponatremia with serum sodium levels below 125 mEq/L. (Hsu and Murray KF, 2014) The study was concerned with assessment of the degree of adherence of medical physicians to Assuit University Protocols for diagnosis of ascites in infants and children. The study included 60 infants and children admitted at Assuit University Children Hospital with ascites Their ages ranged from one month to 18 year . They were 33 males and 27 females during a period of one year. Diagnosis of ascites in infants and children includes: History and physical examination Laboratory studiesImaging studies As regard history History of abdominal swelling, Jaundice, bleeding, fever, lower limb swelling and puffy eyes were recorded in 100%. Change of urine and stool color was recorded in 66.7%. Growth failure and malaise were recorded in 80%. Abdominal pain was recorded in 83.3%. Steatorrhea was recorded in 45%. Cyanosis was recorded in 68.3%. Dyspnea during suckling was recoded only in 15%.Orthopnea and nocturnal dyspnea, Chest pain were recorded in 68.3%. Recurrent attacks of cough and chest wheezing with or without fever were recorded in 71.7%. Anorexia was recorded in 78.3%. Hematuria was recorded in 73.3%. As regard examination General examination including vital signs, pallor, jaundice, cyanosis and edema were done in 100%. Lymph node enlargement was recorded in 86.7%. . Serial measurement of weight was done in 80%. Serial measurement of the abdominal girth was done in 46.7%. Palmar erythema and spider nevi were recorded in 75%. Congested neck veins were recorded in 56.7%. Clubbing of fingers was recorded in 61.7%.Chest and cardiac examination were done in 100%.Abdominal examination including: inspection for presence of abdominal distention, for site and shape of the umbilicus, and for presence of dilated veins and its direction was done in 100%. Palpation for detection of abdominal tenderness, hepatomegaly and splenomegaly was done in 100% while for palpable kidneys was done in 66.7%. Detection of degree of ascites by percussion was done in 100%. Auscultation of the intestinal sounds was recorded in 100%. As regard investigations-Laboratory tests including complete blood count, complete urine examination, liver function tests, kidney function tests and coagulation profile were done in 100% while tuberculin test was done in 48.3%. -Imaging studies including chest and abdominal plain films were done in 38.3%, abdominal ultrasound was done in 100%, CT and MRI were done in 26.7%. Diagnostic upper gastrointestinal endoscopy was done only in 25%.-Abdominal paracentesis for ascitic fluid analysis was done in 36.7%. SAAG was done for all cases of paracentesis (22 cases out of total 60 studied cases). SAAG is a more sensitive and specific measure for the differentiation of ascites due to portal hypertension from ascites due to other pathophysiological mechanisms (e.g. peritoneal inflammation).SAAG is calculated by subtracting the ascites albumin concentration from the serum albumin concentration.SAAG is generally low (<1.1 g/dL) in ascites not due to portal hypertension as in cases of infection or malignancy (not due to portal hypertension). (Finche, et al,. 2012