Ascitic fluid interpretation Flashcards
What are the clinical signs of ascites?
Abdominal distension
Dull percussion note affected by positioning, “shifting dullness”
Tympanic central abdominal note
What are the indications for performing peritoneocentesis?
Uncertain diagnosis
Severe abdominal pain
Suspected spontaneous bacterial peritonitis
Refractory ascites
Therapeutic reasons: respiratory compromise, abdominal compartment syndrome
What are the contraindications to performing peritoneocentesis?
INR >1.5
Platelets <50
Describe how peritoneocentesis is performed.
Aseptic procedure
Local anaesthetic
Advance needle and aspirate
Aspirate 30-60ml of fluid
Where are the safe sites to perform an ascitic tap?
Right or left lower quadrant lateral to rectus sheath
Below umbilicus
How can ascitic fluid be analysed?
Microbiology: cell count, gram stain, culture
Protein/albumin content, compared to serum sample
How can the colour of ascitic fluid be interpreted?
Clear/straw coloured: cirrhosis
Cloudy/yellow: SBP, pancreatitis, perforated bowel
Red/bloody: malignancy, traumatic tap
Chylous: tuberculosis, lymphoma
How is spontaneous bacterial peritonitis diagnosed?
Ascitic fluid containing WCC >500 or neutrophils >250
What is the normal protein count of ascitic fluid?
0.3-4g/dL
What causes an increased protein count in ascitic fluid?
Tuberculosis
SBP
What is the normal range of amylase in ascitic fluid?
Should be similar to serum level
Increased in pancreatitis
What causes an decreased glucose level in ascitic fluid?
Malignancy
TB
What is the serum ascitic albumin gradient?
Indirect measure of portal pressure
Serum albumin - ascitic fluid albumin
What does a high serum ascitic albumin gradient suggest?
Transudate
What does a low serum ascitic albumin gradient indicate?
Exudate
