Introduction: Ascites is the pathologic accumulation of fluid within the peritoneal cavity. Accumulation of fluid in the peritoneal cavity resulting in ascites has many different mechanisms.The proper evaluation of ascitic fluidhelps in narrowing the diagnostic dilemma faced by the physicians and helps in better management of the patients.

Objectives: The present study aims to assess the value of ascitic fluid cytology in the differential diagnosis ofascites along with various biochemical parameters and its usefulness in the patient management.

Material and Methods: This prospective study was conducted in the Department of Pathology, at SNMC Bagalkot
over a period of 6 months from November 2019 to april 2020. This study included 120 patients who presentedwith ascites.Detailed examination – physical, cytological, biochemical and microbiological (wherever indicated)was done.

Results: Most common cause of ascitis was cirrhosis followed by tuberculosis,Malignant ascitis was noted in 8.3%
cases. Ascitic fluid cytology was useful not only in the diagnosis but also to assess the response to treatment in thesecases. The total protein content of ascitic fluid was significantly lower in cirrhotic cases as compared to tubercular,acute infective cases and malignant cases.

Conclusion: The exudative ascites is seen with tubercular acute infective and malignant ascites, with proteincontent >3.0 gm/dl and lower glucose levels while the transudative ascites as seen commonly with cirrhotic asciteshas protein content <3.0 gm/dl and a higher glucose levels.The careful cytomorphological examination of ascitic fluid is a valuable, simple, rapid, inexpensive and reliable
technique in the differential diagnosis of ascites.

Keywords: Ascitic fluid cytology; Transudate; Exudate; Cirrhosis.