Brief Answer:
3 possible causes

Detailed Answer:
hi and welcome.
You can post findings here
generally,there are 3 possible causes of water in abdomen or so called ascites. One is liver cirrhosis, second is heart disorder and third are tumors in abdominal cavity. Rarely,this is seen as end stage kidney disease. She must do certain tests to rule all these disorders out. Send me document and I 'll see what is going on. wish you good health. Regards

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Brief Answer:
hi

Detailed Answer:
Hi again.

I ve gone through these findings and I ll try to explain my expressions.
There is constant Alkaline phosphatase elevation which suggests pathology of biliary system, liver and biliary ducts, also there were elevated liver enzymes at first report. Viral and autoimune hepatitis is ruled out,which is good,and conclusion is generally that these findings are caused by fatty liver. However, fatty liver never causes ascites in abdomen.

Second: there is constant decrease of potassium, this is nonspecific and usually caused by low intake or increased loss due to diarrhea or vomiting. If she is eating normally and there is no diarrhea or vomiting then hypoakaliemia should be further investigated-it means that she must check her hormones( aldosteron, cortisole and antidiuretic hormone).
SLightly increased WBC is also nonspecific and may suggest infectious or malignant process in body.

Other findings in blood and serum are not concerning.
Ascites finding suggests some red blood cells and significant amount of white blood cells and as I see there are no malignant cells.or wasnt tested for it.

The main issue is seen on PET scan: peritoneal thickening,methabolic active...This is not good sign and this rules out liver as a main cause of ascites, but it is suggestive of malignant peritoneal deposits and this would be very bad sign since peritoneal thickening is seen in primary and secondary peritoneal tumors,mostly malignant ones. Also, if these are malignant deposits with ascites, then this would be late stage of malignant disease. I hope that I am wrong and this thickening may still be just fibrosis, inflammation or some other benign condition, but it must be clearly established.

Since PET scan is the most sensitive non-invasive diagnostic tool,the next diagnostic option would be diagnostic laparoscopy.

SO I suggest next: Do additional lab tests: pancreatic enzymes, aldosterone, cortisol levels, tumor markers( CEA, CA 19-9, CA 125, AFP and CYFRA, 5-HIAA).

Repeat ascites fluids samples and send it to cytologic analysis.
DO gynecologist examination and ultrasound to rule out ovarian cancer.

If these findings are fine then laparoscopy should be done which will visualize peritoneal cavity and biopsy of peritoneal thickening can be taken- depending on these results, therapy can be started..

If you have further questions, feel free to ask.
Wish you good health. Regards

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