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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
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