Gastro - Parancetesis Flashcards
What is the peritoneum ?
The space between the visceral peritoneum and the parietal peritoneum
Membrane consists of capillaries and lymphatic vessels ( which allows the fluid to leak into that space)
If secretion is increased or reabsorption blocked-ascites
**if secretion is increase and more pearmeadle and leaky*
Indications for Paracentesis ?
Performed on cases of unexplained ascites to determine cause
Performed to relieve intra-abdominal pressure from the fluid
Paracentesis pre-procedure?
Obtain informed consent (written)
Pt should empty bladder before procedure
so we don’t puncture it
Measure abdominal girth - we wanna know how much fluid we are taking out
Obtain pt weight
Obtain baseline VS
Paracentesis procedure?
Use sterile technique
Anesthetize locally
Make small stab wound incision
A trocar, cannula, or catheter can be placed through the incision.
Plastic tubing is then connected to vacuum device or collection device
4L max removed at one time
**fluid in the abd push intestines up and posterior *
Paracentesis post-procedure?
Labs on the fluid should be performed immediately
Measure abdominal girth
Measure pt weight
Monitor VS (watch for hypotension)
Monitor serum protein and sodium levels
Albumin?? its a transport protein - might be abnormal because of lover disease
Transudate examples?
CHF
Chirrosis
Nephrotic Syndrome
hypoproteinemia
** happening from something or somewhere else *
Exudate examples?
Infection - SBP
Neoplasm
Less likey: pulmonary infarction, trauma, drug hypersensitivity
** happening right thee in the abd*
Paracentesis fluid Normal fluid color?
Normal: clear-light yellow, serous
Paracentesis milk-colored fluid color?
lymphoma, carcinoma , TB
Paracentesis cloudy/turbid color fluid?
Cloudy/turbid: peritonitis, pancreatitis, appendicitis
Paracentesis bloody color fluid?
Bloody: traumatic tap, hemorrhage, tumor
Paracentesis bile-stained fluid color?
Bile-stained: ruptured GB, acute pancreatitis, ruptured intestines
Paracentesis cell counts: RBC normal count?
none
if there is some then it indicates neoplasm, TB, bleeding
Paracentesis cell counts: WBC if transudate?
normal
Paracentesis cell counts: WBC if exudate?
Exudate = elevated, neutrophils ( cancers and infections)
Total protein fluid/serum ratio if transudate?
Transudates: <0.5
Total protein fluid/serum ratio if exudate?
Exudates: >0.5 ( 8/4 ration = 2) - high protein in fluid than serum
What is the most accurate way to differentiate between transudate vs. exudate?
Total protein fluid/serum ratio
Protein count if transudate?
Transudates: <3g/dL
Protein count if exudate?
Exudates: >3 g/dL - more protein in th fluid-
Usually glucose serum _______ peritoneal fluid levels?
equals
When will glucose be decreased?
Bacterial infections
SBP (spontaneous bacterial peritonitis)
b/c glucose being eaten up back bacteria
When is Amylase increased?
Pancreatic trauma
Pancreatic pseudocyst
Acute pancreatitis
Intestinal necrosis or perforation
**high amylase and concern for intestinal necrosis and they have ascites then at can further dx ywhat you thought it was /*
ammonia appears on paracentesis if?
Ruptured ulcer, appendix, intestine
**ammonia coming out of the bowel *
When is alk. pos. increased?
Found in intestinal mucosa so elevated with intestinal infarction or strangulation
**elevated with intestinal necrosis *
Lactate Dehydrogenase is an enzyme found in?
many body tissues
If using peritoneal fluid/serum LDH ratio what would the number be if it is exudate?
Exudate: > 0.6
** more stuff in the fluid than the serum*
What does cytology examine?
paracentesis fluid for cancerous cells:
Ovarian
Pancreatic
Colon
gastric
What if bacteria is present in the paracentesis fluid?
Present: Primary peritonitis Appendicitis Pancreatitis TB
**Peritoneal fluid is sent for gram stain, culture, and sensitivity testing (C&S)
*
When is carcinoembryonic antigen elevated?
GI cancers
Contrindications to Paracentesis?
DIC - they will bleed out
AC therapy - anti coagulated - weight risk vs. benefits
Bleeding disorders
Extensive previous abd surgeries - be cautious cause scarring / adhesions - adhesions obscuring normal morphology
Small amount of fluid
Potential complication of Paracentesis?
Peritonitis
Hypovolemia
Seeding needle tract with malignant cells
Causes of Transudate fluid?
Hepatic cirrhosis Portal HTN Nephrotic syndrome CHF Abdominal Trauma Peritoneal Bleeding
causes of exudate fluid?
Lymphoma Carcinoma TB Peritonitis Pancreatitis Ruptured viscus
Stool Studies include?
C.diff Culture Fecal fat Fecal leukocytes Occult Blood Ova and parasites
Fecal leukocytes evaluates for the presence of ___ in the stool
WBC
Fecal leukocytes normal ?
Normal: none
May be normal with viral diarrhea or parasitic infection
When is fecal leukocytes elevated?
Bacterial or infectious diarrhea
Perirectal abscess
Anorectal fistula
Stool cultures look for what ?
Salmonella Shigella Campylobacter Yersinia E.coli Staph aureus
Indication to check for C.Diff?
Abx for > 5 days
Immunosuppressed patients
Unrelenting watery, foul-smelling diarrhea
C.Diff toxin assay?
stool
colonic-rectal tissue
C.diff stool studies?
toxin assay
culture
positive = infection
Indications for fecal fat test?
Confirm diagnosis of steatorrhea
Test explanation for fecal fat?
Total output of fecal fat per 24 hours in 3 day stool collection
**pancreatic stuff / CF *
Interfering factors to fecal fat test: increased?
Enemas
Laxatives
mineral oil
**anything that has oils in it *
Interfering factors to fecal fat test: decreased?
Barium
Fiber laxatives
Fecal Fat test results show increased levels because of what?
Cystic Fibrosis
Malabsorption : celiac disease, Crohns etc
Short-gut syndrome
Maldigestion secondary to obstruction of the pancreatobiliary tree
Tumor markers?
AFP BRAF mutation CA 19-9 CA 125 CEA CD20 KIT
