The study was conducted in a tertiary care hospital of Rohilkhand region located in the Northern India, over a period of 8 months from January 2016 to August 2016. All patients diagnosed as ascites on the basis of history, physical examination, ultrasonography, and age >18 years admitted in medicine department of Rohilkhand Medical College & hospital (RMCH), Bareilly (U.P) were included in the study. Patients of peritonitis and unwilling to participate in the study were excluded. The patients included in the study were evaluated by detailed history and physical examination. Ascitic fluid paracentesis and virologic testing for Hepatitis B and C were done in all the patients. Ascitic fluid was analyzed for cytology, biochemistry, gram staining, acid fast bacillus staining, malignant cells, culture, and sensitivity and for adenosine deaminase (ADA). Serum-ascites albumin gradient (SAAG) was estimated in all patients. Ultrasound abdomen was done in all patients followed by computed tomography if the ultrasound was inconclusive or if there was evidence of any intra abdominal malignancy. Specific etiology oriented investigations were carried out. Other investigations such as antinuclear antibodies, an antibody against liver-kidney-microsomes, anti smooth muscle antibodies, serum ceruloplasmin, urinary copper levels and slit lamp examination for Kayser–Fleisher ring were done if indicated. Cirrhosis was diagnosed on basis of physical examination and ultrasonography. Tubercular ascites was diagnosed on the basis of lymphocytic predominance on cytology, low SAAG (<1.1), high protein (>2.5), ADA more than 40 IU/L. The data, thus collected, was analyzed on Microsoft Excel sheet 2010 and percentages were calculated.
Cirrhosis was found to be the most common cause of ascites (60.78% patients), followed by tuberculosis (15.68% patients). Although cirrhosis was the leading cause of ascites, causes other than cirrhosis were present in around 37% of the patients. Among cirrhotics Hepatitis b was the leading cause of cirrhosis (41.93% patients). India accounts for a large proportion of the worldwide HBV burden. India harbors 10-15% of the entire pool of HBV carriers of the world. It has been estimated that India has around 40 million HBV carriers. About 15–25% of HBsAg carriers are likely to suffer from cirrhosis and liver cancer. While horizontal transmission in childhood appears to be a major route of transmission, the role of vertical transmission is probably underestimated. Blood transfusion and unsafe therapeutic injections continue to be important modes of transmission of HBV. There should be a focus on screening for hepatitis b in high risk individuals including, intravenous drug users, persons who receive blood transfusions, acupuncture, tattooing, unsafe injection practices, health care workers at risk of occupational exposure, etc. Identification and if necessary treatment of the HBV infected persons would play a role in decreasing the spread of the disease. Focus on primary prevention by hepatitis B vaccination is recommended. The advantages of this study is that the causes of ascites in Rohilkhand region were known which can help us in directing treatment decision, predicting the outcome and in formulating the future preventive strategy.