General Abdomen: Chylous Ascites

Chylous Ascites

Basics

  • Milky Peritoneal Fluid from Lymphatic Obstruction or Damage
  • Causes:
    • Most Common in West: Malignancy (Lymphoma #1)
    • Most Common in Developing World: Infectious (Filariasis #1, TB)
    • Other: Cirrhosis, Trauma & Intraoperative Injury

Diagnosis

  • Dx: Paracentesis (Triglycerides ≥ 110 mg/dL)

Treatment

  • Tx: Dietary Modification (High Protein, Low Fat & Supplement Medium-Chain Fatty Acids)
    • Medium-Chain Triglycerides Reduce Production & Flow of Chyle
      • Long-Chains Absorb into Lymphatics
      • Medium-Chains Absorb Directly into Portal System
  • If Large with Pain/Dyspnea: Total Paracentesis
  • If Refractory with Cirrhosis: Consider TIPS

Chylous Fluid Drained from the Abdomen1

References

  1. Matani S, Pierce JR Jr. Spilt Milk: An Unusual Cause of Bilateral Chylothorax. J Investig Med High Impact Case Rep. 2015 Apr 22;3(2):2324709615583877. (License: CC BY-3.0)