Ascites other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Paracentesis is sampling ascites fluid through abdominal wall with overall complication rate of not more than 1%. The sampled fluid will be surveyed upon total protein concentration, neutrophil count, and inoculation into blood culture bottles.

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Paracentesis is sampling ascites fluid through abdominal wall with overall complication rate of not more than 1%.^[1]
The sampled fluid will be surveyed upon:^[2]
- Total protein concentration
- Neutrophil count
- Inoculation into blood culture bottles
Paracentesis findings include:^[3]^[4]
- Protein concentration <1.5 g/dL is predictive of high risk for spontaneous bacterial peritonitis (SBP)
- Neutrophil count of > 250 per mm³ is diagnostic of SBP
- Positive culture of ascites fluid is diagnostic of SBP
- Measuring serum-ascites albumin gradient (SAAG) is also helpful for diagnosing the underlying disease

Routine Tests	Optional (infection suspicion)	Unusual	Unhelpful
Cell count and differential Albumin Total protein	Culture Glucose Lactate dehydrogenase Amylase Gram’s stain	Acid fast bacterial stain and culture Cytology Triglyceride Bilirubin	pH Lactate Cholesterol Fibronectin Glycosaminoglycan

↑ Runyon BA (1986). “Paracentesis of ascitic fluid. A safe procedure”. Arch. Intern. Med. 146 (11): 2259–61. PMID 2946271.
↑ Biecker E (2011). “Diagnosis and therapy of ascites in liver cirrhosis”. World J Gastroenterol. 17 (10): 1237–48. doi:10.3748/wjg.v17.i10.1237. PMC 3068258. PMID 21455322.
↑ Rimola A, García-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, Inadomi JM (2000). “Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club”. J. Hepatol. 32 (1): 142–53. PMID 10673079.
↑ Runyon BA, Hoefs JC, Morgan TR (1988). “Ascitic fluid analysis in malignancy-related ascites”. Hepatology. 8 (5): 1104–9. PMID 3417231.
↑ “Management of Adult Patients with Ascites Due to Cirrhosis” (PDF).