How to distinguish liver cirrhosis ascites and malignant ascites? 's symptom

How to distinguish liver cirrhosis ascites and malignant ascites? 's symptom
The malignant ascites can block the blood vessel or lymphatic vessel for the leaking (oppression, influence the pulse of door or lymphocytic reflux) , courage and uprightness (corrode and destroy blood vessel or cancerous swelling to break) ,It can also be the exudative and seepage no typicality. Even so, still common with the exudative top. But the person who erupts malignant ascites simultaneously of liver cirrhosis, not by seepage the typicality is seen more, have a lot of similarity with the benign inflammation ascites in examining the index, but the treatment, prognosis of the two are completely different, must further distinguish. (1)Courageous and upright ascites: If obvious courage and uprightness or ascites erythrocyte> 100,000 L of the naked eye, the erythrocyte: Leucocyte> 10: 1,Suspect hepatocarcinoma breaking, peritoneum shifting or malignant ascites due to other tumours at first; If is light courage and uprightness or erythrocyte (2)Ascites pH: Most pH at the time of inflammation7.4. (3)Ascites albumen: Because of peritoneum inflammation and blood capillary penetrating increase at the time of the malignant ascites, the albumen content of the ascites increases, often in 30g above L, the ascites serum albumin ratio is mostly> 0.5, or serum - albuminous density gradient of ascites is diminished, often (4)The ascites dissolves fungus enzyme: Cancer cell include lysosome, have, dissolve the intersection of fungus and enzyme, produce, so ascites dissolve enzyme of fungus increase in exudative or inflammation ' (5)Enzyme lactic dehydrogenase of ascites (LDH) : LDH> 3.34 mol (L second) in the exudative ascites ,Ascites serum LDH ratio> 0.6, often or infect for cancerous swelling. Such as LDH> 8.35 mol/ (L second) ,Ascites serum ratio> 1.0, highly brief on the malignant ascites. LDH can obviously rise, loses diagnosing and distinguishes the meaning at the time of the courageous and upright ascites. LDH isoenzyme analyzes that there is certain value too, with LDH in the malignant ascites3,4,5It is a main fact, but the liver cirrhosis ascites is with LDH2It is a main fact. (6)The fiber connects albumens(FN) : One macromolecule glycoprotein, molecular weight 400,000-45 Wan, mainly produce as fibrous cell, blood vessel endothelial cell and macrophage, when there is solubility (blood, humoral) With the infusibility (while organizing) Two kinds. The former recuperates the function importantly, participate in defending the mechanism to infection and tumour of organism, promote witheredly to deny the phagocytosis of cells; The latter organizes a kind of composition of the ground substance outside cells, main function adheres to functions, can impel among cells, cells and adhering to in order to maintain the normal shape of cell each other the ground substances. At the time of the malignant ascites, may release FN, cancer cell, decompose the intersection of FN and the intersection of person who release and factor in the ground substance make FN rise obviously in the ascites because it is upgraded fast that the cancer cell formate and secrete FN, cancer cell membrane albumen, often> 75mL/L. The intersection of liver cirrhosis and simple ascites, because liver damage formate, reduce, and because large and difficult to leak molecule its, belly water content high, liver cirrhosis lose compensate issue and FN does not increase at the hepatocarcinoma, while erupting SBP simultaneously, perhaps FN is nursed one's health to consume to make it not increase. But can increase at the time of tuberculosis peritonitis. (7)Ascites tumour mark thing: Embryo antigen of cancer (CEA) >15 g/L, sees in the malignant ascites, and announce gland cancer; Child albumen of ascites first (AFP) Rise, announce the metastasis of cancer of primary liver. (8)Valley ammonia acyl of ascites is transferred to peptide enzyme ( - GT) , hydrogen base peptide enzyme (LAP) leucine : - GT and LAP mainly exist in the cover on the bile duct in the cytoplasm of liver and liver in the liver, rise obviously in the ascites, have the intersection of obstructive jaundice and patient, two enzyme this help the intersection of hepatocarcinoma and whom peritoneum shift judge. (9)The ferritin of ascites: Exudative ascites such as> 500 g/L or ferritin ascites serum ratio> 1.0, often brief on the malignant ascites. (10)Cholesterol of ascites: Cholesterol of ascites> 1.24mmol/L, then the possibility of tumour is great. But can also increase at the time of some SBP and tuberculosis peritonitis, noteworthy while distinguishing. (11)The chromosome core type of the ascites is analyzed: There is more chromosome that is split in the malignant ascites alikely, the unusual or distortion that not whole time of body of ultra liploid appears, it is not the cancer ascites that has not made a variation. This checks higher specificity, sensitiveness and practical value, its meaning is superior to the generally cytologic inspection. The hair person in Suwon of malignant belly is rare, rely mainly on continuing the hair, come from liver, intestines and stomach and ovary more, should pay attention to checking.
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