Abstract Background: Differential diagnosis of ascites is a common clinical problem. Less expensive biochemical techniques are required to differentiate ascites with unknown etiology. Aim: To evaluate the diagnostic efficiency of ascitic fluid cholesterol, serum ascites albumin gradient (SAAG) and serum ascites cholesterol gradients (SACG) in differentiating cirrhotic, tuberculous and malignant ascites. Methods: 50 patients (25 with hepatic cirrhosis, 15 with tuberculosis and10 with malignancy) were evaluated for ascitic fluid total protein, albumin, cholesterol, SAAG and SACG. Results: The mean ascitic fluid cholesterol was significantly higher in malignant ascites when compared with cirrhosis and tuberculous ascites (p= 0.0001 each). The difference between tuberculous and cirrhotic ascites was also significant (p= 0.001). The mean value of SAAG was significantly higher in cirrhosis when compared with tuberculous and malignant ascites (p= 0.0001; p= 0.001 respectively) but the difference between tuberculous and malignant ascites was not significant The mean SACG was significantly lower in malignant compared to tuberculous and cirrhotic ascites (p= 0.0001; p= 0.001 respectively). The difference between tuberculous and cirrhotic ascites was not significant. Conclusion: SAAG is a better marker to differentiate cirrhotic ascites from tuberculous and malignant ascites. Ascitic fluid cholesterol and SACG are better markers to differentiate malignant ascites from cirrhotic and tuberculous ascites. [Vyakaranam S et al. NJIRM 2011; 2(3) : 22-28]
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