Indications
for diagnostic paracentesis.
-
Cirrhotic
patients with ascites at
admission
-
Cirrhotic
patients with ascites and
signs or symptoms of
infection: fever, leukocytosis,
abdominal pain
-
Cirrhotic
patients with ascites who
present with a clinical
condition that is
deteriorating during
hospitalization: renal
function impairment, hepatic
encephalopathy,
gastrointestinal bleeding
-
Patients
with new-onset ascites
Analysis
of Peritoneal Fluid
|
Test and Ascitic-Fluid
Container |
Comments |
|
Albumin |
Differential diagnosis of
ascites according to the
serum–ascites albumin
gradient |
|
Cell |
Cell
count and differential count |
|
Culture |
Aerobic-
and anaerobic-culture |
Additional Analyses of Ascitic
Fluid
|
Test and Ascitic-Fluid
Container |
Comments |
|
Tube without additives |
|
Total protein |
Values
>1 g/dl suggest
secondary peritonitis
instead of SBP |
|
Lactate dehydrogenase |
Values greater than the
upper limit of normal for
serum suggest secondary
peritonitis instead of SBP |
|
Glucose |
Values <50 mg/dl suggest
secondary peritonitis
instead of SBP |
|
Carcinoembryonic antigen |
Values >5 ng/ml suggest
hollow viscus perforation |
|
Alkaline phosphatase |
Values >240 U/liter suggest
hollow viscus perforation |
|
Amylase |
Values markedly elevated
(often >2000 U/liter or five
times serum levels) in
patients with pancreatic
ascites or hollow viscus
perforation |
|
Triglyceride |
Values >200 mg/dl suggest
chylous ascites |
|
Syringe or evacuated
container |
|
Cytology |
Sensitivity increased if
three samples submitted and
promptly evaluated |
|
Mycobacterial culture |
Sensitivity only 50% |
Differential Diagnosis of
Ascites According to the Serum–Ascites
Albumin Gradient
|
Gradient
>1.1
g/dl (portal hypertension) |
Gradient <1.1 g/dl |
|
Cirrhosis
Alcoholic hepatitis
Cardiac ascites
Portal-vein thrombosis
Budd-Chiari syndrome
Liver metastases |
Peritoneal carcinomatosis
Tuberculous peritonitis
Pancreatic ascites
Biliary ascites
Nephrotic syndrome
Serositis |
The diagnosis
of SBP is suggested by a
polymorphonuclear (PMN) cell
count in excess of 250 cells per
cubic millimeter in the absence
of evidence of an alternative
source of infection (secondary
peritonitis), such as viscus
perforation or intraabdominal
abscess.
Determination
of total protein, lactate
dehydrogenase, and glucose
levels in ascitic fluid may aid
in the differentiation between
SBP and secondary peritonitis.
Culture is used to confirm the
diagnosis of SBP.
Related Criteria
Diagnostic Criteria for Zollinger-Ellison Syndrome (ZES)
Diagnostic Criteria for
Autoimmune Hepatitis (AIH)
Diagnostic Criteria for Wilson's disease
Severity Criteria for Acute
Pancreatitis
More...
References:
