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Peritoneal Fluid Analysis

Peritoneal fluid (ascitic fluid) analysis

Theperitoneumis a tough semi-permeablemembrane lining abdominal and visceral

cavities. it encloses, supports and lubricates

organs within the cavity.Paracentesisiseffectively the analysis of Ascites the

abnormal accumulation of fluid within the

abdomen.

The peritoneum is important in osmoregulationo Passive diffusion of water and solute (up to a

certain size)

o Maintains osmotic and chemical equilibriumwith blood and lymph

Ascitesdevelops either from:o Increased accumulation Increased capillary permeability Increased venous pressure Decreased protein (oncotic pressure)o Decreased clearance Increased lymphatic obstruction

Cause

Transudate(30g/L protein) (Local disease)o Malignancyo Venous obstruction e.g. Budd-

Chiari, Schistosomiasis

o Pancreatitiso Lymphatic obstructiono Infection (especially TB)

Analysate Interpretation

Gross appearance

Clear to pale yellow Normal

Milk-coloured

(Chylous)

Malignant tumour,

lymphoma, TB

Parasitic infection,

hepatic cirrhosis

Cloudy/turbid Peritonitis, Primary

bacterial infection

Perforated bowel,appendicitis, pancreatitis

Strangulated or infarcted

bowel

Bloody tap Benign or malignant

tumour

Haemorrhagic

pancreatitis, perforated

ulcer

Paracentesis biochemistry

Levels Interpretation

Triglyceride Elevated Malignant

tumour,

lymphoma, TB

Parasitic

infection,

hepatic

cirrhosis

Protein 0.3-4.0g/dL

>4g/dL

Normal

TB, SBP

Glucose 7-10

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Exudate Serum:Ascites Ratios

Evidence for these ascites:serum ratios iscontroversial

o Ascitic fluid protein/Serum Protein >0.5o Ascitic Fluid LDH/Serum LDH >0.6o Ascitic Fluid LDH >400 Presence of any 2 of these three findings is

usually associated with TB, Malignancy

or Pancreatitis

Absence of all three usually indicates hepaticcause

The Serum-Ascites Albumin Gradient (SAAG)

The SAAG has become more favored in helpingto characterize ascites fluid

The concept surrounds oncotic-hydrostaticbalance

Simple calculation:o Serum albumin Ascites albumin= SAAG

SAAG > 1.1 mg/dl SAAG < 1.1 mg/d

Cirrhosis

Alcoholic Hepatitis

Cardiac Ascites

Mixed Ascites

Massive Liver

Metastasis

Fulminant Hepatic

Failure

Budd-Chiari

Syndrome

Portal Vein

Thrombosis

Veno-Occlusive

Disease

Myxedema

Fatty Liver of

Pregnancy

Peritoneal

Carcinomatosis

Tuberculous Peritonitis

Pancreatic Ascites

Bowel Obstruction

Biliary Ascites

Nephrotic Syndrome

Posteroperative

Lymphatic Leak

Serositis in Connective

Tissue Disease

Microscopy And Analysis

Red cell count Interpretation

None Normal

>100/microlitre

>100,000/microlitre

Malignancy, TB

Intra-abdominal

trauma (DPL)

White cell count Interpretation

300/microlitre

>25% neutrophils

>25% lymphocytes

Mesothelial cells

Gram +ve cocci

Gram ve

Normal

Abnormal

SBP (90%), cirrhosis

(50%)

TB or Chylous

Ascites

TB peritonitis

Primary peritonitis

Secondary

peritonitis