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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Abdominal Pain And Hepatomegaly?

Hi, I have been having moderate pain in my lower abdomen since the past three months. Ultrasound revealed mild ascites in pelvic cavity and mild hepatomegaly. Mantoux test is positive and ESR is raised. The doctors tried to take a sample of the fluid by putting a needle in my pelvis but were unsuccessful. Both Colonoscopy and Chest x-ray are clean. No fever, nausea, weight loss. The doctors are sayng it is Tuberculosis. I want to know if there can be a possibility of it being something else.
Tue, 2 May 2017
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Internal Medicine Specialist,  's  Response
Tuberculosis is an infection and is likely to cause some systemic symptoms like fever, night sweats or weight loss. Positive Mantoux test may not be sufficient to make a diagnosis of TB as a cause of hepatomegaly and ascites.
Below is a list of conditions which can cause ascites: liver diseases are the most common causes - among them hepatitis and cirrhosis.
Your doctors should have checked your so called liver function tests = LFTs.
If these are abnormal it means your liver is the problem. If LFTs are normal, other diseases may be the cause of your findings.

Etiology of Ascites
Cause     % of all cases
Chronic liver disease (cirrhosis or chronic hepatitis)     80%
Underlying malignancy     10%
Congestive heart failure     3-5%
Cirrhosis and another etiology     5%
Infection: Tuberculous peritonitis     1%
Infection: Chlamydia (*Fitz-Hugh-Curtis syndrome)     Infection: **HIV-related ascites     Renal disease (nephrotic syndrome, dialysis-related     Fulminant hepatic failure     Pancreatic     Biliary     Chylous     * perihepatitis rarely due to gonococcus
**Note: ~5% of pts with AIDS have ascites detected by ultrasound; many etiologies
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What Causes Abdominal Pain And Hepatomegaly?

Tuberculosis is an infection and is likely to cause some systemic symptoms like fever, night sweats or weight loss. Positive Mantoux test may not be sufficient to make a diagnosis of TB as a cause of hepatomegaly and ascites. Below is a list of conditions which can cause ascites: liver diseases are the most common causes - among them hepatitis and cirrhosis. Your doctors should have checked your so called liver function tests = LFTs. If these are abnormal it means your liver is the problem. If LFTs are normal, other diseases may be the cause of your findings. Etiology of Ascites Cause % of all cases Chronic liver disease (cirrhosis or chronic hepatitis) 80% Underlying malignancy 10% Congestive heart failure 3-5% Cirrhosis and another etiology 5% Infection: Tuberculous peritonitis 1% Infection: Chlamydia (*Fitz-Hugh-Curtis syndrome) Infection: **HIV-related ascites Renal disease (nephrotic syndrome, dialysis-related Fulminant hepatic failure Pancreatic Biliary Chylous * perihepatitis rarely due to gonococcus **Note: ~5% of pts with AIDS have ascites detected by ultrasound; many etiologies