How is chylous ascites characterized?

• A. Milky appearance with high triglycerides in ascitic fluid.
• B. Bloody ascites with clots.
• C. Clear straw-colored ascites with low protein.
• D. Purulent ascites with bacterial growth.

Answer: (A)

Chylous ascites results from leakage of lymphatic fluid into the peritoneal cavity, so the fluid appears milky due to its triglyceride-rich content and the presence of chylomicrons. The strongest identifying feature is a high triglyceride level in the ascitic fluid, typically well above normal serum levels (often cited as around 200 mg/dL or higher), with confirmation by detecting chylomicrons on lipoprotein analysis. This distinguishes it from other forms of ascites.

Bloody ascites with clots points to hemorrhagic processes, a clear straw-colored fluid with low protein suggests a transudate from portal hypertension, and purulent ascites indicates infection. None of these have the characteristic milky appearance with elevated triglycerides that define chylous ascites.