Feb 01, 2018 protein ascitic fluid had been classified as an exudate if the total protein concentration is. Pdf ascitic fluid analysis in the differential diagnosis of ascites. Perform the ascitic tap and withdraw 2025ml of ascitic fluid. Diagnostic ascitic paracentesis tap sampling standards. The correlation between cytological examination of ascitic. Ascitic fluid analysis ascites is a condition that is characterized by the accumulation of fluid in the abdominal region. It is one of the earliest and most common complication of chronic liver disease. Approach the examination of the liver from the right side of the patient. Along with pleural fluid, peritoneal fluid is frequently sent to the laboratory for biochemical analysis. Often, it occurs due to improper functioning of liver that leads to abnormal accumulation of fluid in the space present between the lining of the organs and the abdomen. In the united states, ascites is most often due to portal hypertension resulting from cirrhosis. Common causes of ascites are liver disease or cirrhosis, cancers,and heart failure. Approach to the patient with ascites differential diagnosis.
Aim of the presentation is to give a very clear understanding about the analysis of ascities. In addition, at time of any hospital admission, a diagnostic. Ascites is a pathological accumulation of fluid in the peritoneal cavity. Protocol for the examination of specimens from patients. Measurement of total protein, glucose, and lactate dehydrogenase ldh in ascites. How valuable is ascitic cytology in the detection and. A 59yearold portuguese caucasian man with a history of heavy alcohol intake and no significant medical history presented with ascites, weight loss and general malaise. Aetiology, ascites, ascitic fluid analysis, diagnosis, liver cirrhosis. Ascitic fluid with ammonia odor as a symptom of bladder. Diagnosis and management rita sood abstract ascites, the collection of fluid in the peritoneal cavity, occurs with a variety of disease states. Gk, askos, bag a watery fluid containing albumin, glucose, and electrolytes that accumulates in the peritoneal cavity in association with certain diseases, such as liver disease or congestive heart failure. Laboratory analysis of ascitic fluid helps in the differential diagnosis of ascites.
The abdominal ultrasound confirmed the presence of chronic. If diagnostic paracentesis shows serum to ascitic fluid albumin gradient is ascitic fluid may include culture in blood culture bottles if infection is suspected, it is a routine test. Presentation will help the medical residents diagnose the cause of fluid accumulation in abdomen and thus will. Ascites is the pathologic accumulation of fluid within the peritoneal cavity. Pdf ascites is the pathologic accumulation of fluid within the peritoneal cavity. In general, patients must have at least 1500 ml of fluid to be detected reliably by this method. Routinely, a cell count and differential should be performed on ascitic fluid. Causes of ascites rare causes ascites analysis of ascitic fluid aasld ascites guideline indications for paracentesis serum albumin ascites gradient related topics.
Ascitic fluid cytology and flow cytometry in the primary. Nov 30, 2016 peritoneal or ascitic fluid analysis evaluates the abnormal buildup of fluid in a patients abdomen. The value of examination of ascitic fluid and blood for lipids and for proteins by electrophoresis author links open overlay panel randolph a. Ascitic fluid analysis in the differential diagnosis of.
The value of a cell count and bacterial culture of the ascitic fluid is not disputed, but the role of biochemical testing is less clear. The ascitic fluid analysis showed 921 cellsmm3 with mononuclear predominance 93. In cirrhosis, it is associated with circulatory dysfunction characterized by. Collection, transport, and examination of ascitic fluid possible pathogens gram positive enterococci streptococcus pneumoniae staphylococcus aureus streptococcus pyogenes streptococcus agalactiae viridans streptococci clostridium perfringens acid fast bacilli mycobacterium tuberculosis gram negative escherichia coli klebsiella strains. Vijay kumar bodal, preeti banasal, manjit singh bal, anil kumar suri, ranjeev bhagat, navneet kaur, mohanveer kaur and anikita goel. Pdf analysis of ascitic fluid for cytological and biochemical. Presentation will help the medical residents diagnose the cause of fluid accumulation in abdomen and thus will guide to adopt the appropriate pathway to solve the issue. Too much hope is placed on ascitic cytology to provide the diagnosis at the expense of other investigations. Many diseases can cause ascites, but the most common is portal hypertension, which is usually due to cirrhosis.
Peritoneal paracentesis adult, peds uc san diego health. This is in comparison to paracentesis where a drain is inserted so larger volumes can be removed. Ascitic tap paracentesis ideally all ascitic interventions should be ultrasound guided indications for ascitic tap paracentesis to aid diagnosis of the cause of ascites or in the diagnosis or exclusion of sbp a diagnostic paracentesis should be performed in all patients with new onset grade 2 or 3 ascites, and in all patients hospitalized for. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. A brief overview of ascitic fluid analysis, including how to interpret ascitic fluid results and how to differentiate between an exudate and a transudate. Because many diseases can cause ascites, in particular cirrhosis. Department of pathology, government medical college, patila, punjab, india. Ankush explains about ascites, peritoneal fluid tests, its procedure, result interpretation.
If the ascitic fluid is difficult to find on physical examination or if there is significant bowel dilatation, ultrasonography can be used to help locate the fluid pocket and visualize the spleen and other structures to guide this procedure. Put on sterile examination gloves while skin disinfectants dry. A simplified description of ascitic fluid analysis. The ascitic fluid can be graded into transudative and exudative fluid based on the serum ascites albumin gradient saag. Protocol for the examination of specimens from patients with primary tumors of the ovary, fallopian tube, or peritoneum. Fluid accumulation may be due to infection and malignancy or due to other diseases like liver disease, heart failure, and renal disease. Because many diseases can cause ascites, in particular cirrhosis, samples of ascitic fluid are commonly analyzed in order to develop a differential diagnosis. No single maneuver is both highly sensitive and specific. The asssociation of clinical biochemists in ireland the biochemistry of body fluids version 1. Hence, examination of the urea and creatinine levels in the ascitic fluid, 6 cystography, and cystoscopy are useful tests to establish the diagnosis. In this study, we aimed to investigate whether there is any correlation between cytological examination of ascitic fluid and serum ascites albumin gradient saag in the determination of etiologic causes of ascites. Analysis of ascetic fluid for cytological and biochemical. Ascitic fluid samples are frequently sent to the laboratory for analysis.
Dec 29, 2017 any patient with ascites and fever should have a paracentesis with bedside blood culture inoculation and cell count. Ascitic fluid total protein and the serumascites albumin gradient saag for many years, the ascitic total protein concentration has been used to determine whether ascitic fluid was a transudate or exudate. Currently, it is accepted that the accuracy of the relationship between ascitic protein concentration and. Fluid of other colour or consistency may reflect specific underlying disease processes see table. Dec 17, 2018 ascites tapping is usually undertaken to take off small volumes of ascites for analysis. Ascites is the pathological state in which fluid accumulates in the peritoneal cavity. The yield of organisms on smear and culture is low. Jun 21, 2014 a simplified description of ascitic fluid analysis. Ascites is accumulation of fluid in the abdominal cavity. Review the diagnostic workup in patients with ascites. The abdominal ultrasound confirmed the presence of. Combined analysis of laboratory data of ascitic fluid samples and clinical and pathological data is essential for establishing a differential diagnosis. Health, general ascites analysis cytodiagnosis usage exudates and transudates.
Prophylactic antibiotic therapy with a quinolone is often recommended. Analysis of ascetic fluid for cytological and biochemical findingsx. Ascitic fluid analysis in the differential diagnosis of ascites. Ascitic fluid definition of ascitic fluid by medical. For the best exam, make sure the patient is warm and comfortable. Simple assessment of the progress of ascites may be made by serial measurements of the abdominal girth. Several millileters of ascitic fluid are sufficient to obtain a differential cell count. Ascites is the abnormal buildup of fluid in the abdomen. Accumulation of fluid within the peritoneal cavity results in ascites. The study was conducted on 68 subjects and found that both ascitic fluid examination and saag were significantly compatible to the clinical diagnosis, 25. Complications can include spontaneous bacterial peritonitis. Abdominal paracentesis and a careful analysis of ascitic fluid is the single most important procedure and should be an early step in evaluating a patient with.
Although the underlying cause of the ascites is often thought to be clinically obvious, it is important to establish a definitive diagnosis. Place a swab or cotton wool over the site and apply gentle pressure while withdrawing the needle. Other common causes include malignancy and heart failure. Ascitic fluid cytology in suspected malignant effusions. It is appropriate to sample ascitic fluid in all patients with newonset ascites as well as in all those admitted to the hospital with ascites, as there is a 10% to 27% prevalence of ascitic fluid infection in the latter group. Pdf value of adenosine deaminase ada in ascitic fluid for. If diagnostic paracentesis shows serum to ascitic fluid albumin gradient is paracentesis ideally all ascitic interventions should be ultrasound guided indications for ascitic tap paracentesis to aid diagnosis of the cause of ascites or in the diagnosis or exclusion of sbp a diagnostic paracentesis should be performed in all patients with new onset grade 2 or 3 ascites, and in all patients hospitalized for. History and physical examination in the united states, in approximately 85% of patients with ascites, cirrhosis is the cause, but 15% have a non. Signs and symptoms of ascities include shortness of breath, and abdominal pain, discomfort, or bloating. Its etiology includes gastrointestinal, genitourinary, cardiac and metabolic disorders, infections. Analysis of ascitic fluid for cytological and biochemical findings. The tape measure must be placed in the same position each time. Ascitic fluid cytology in suspected malignant effusions with special emphasis on cell block preparation.
An ascitic fluid analysis is a test that is conducted on the peritoneal fluid during a case of ascites. Successful treatment of ascites depends upon an accurate diagnosis of its cause table 1 and table 2 and table 3 and. Diagnostic via either ascitic tap or paracentesis newonset ascites. Mar 15, 2014 ascites is the pathologic accumulation of fluid within the peritoneal cavity.
Patients with a protein level of less than 1 gdl in ascitic fluid are at high risk for the development of spontaneous bacterial peritonitis. The most sensitive means for determining whether ascitic fluid is present is to test for shifting dullness. This tends to be much faster than gain or loss of fat or lean body mass. Ascites is the accumulation of ascitic fluid in the peritoneal cavity. A serumascites albumin gradient saag can be obtained by simultaneous measurement of ascitic and serumascites albumin gradient.
The sensitivity of these maneuvers is limited by the amount of peritoneal fluid present, and ultrasound is useful in defining small amounts of fluid. Report by journal of evolution of medical and dental sciences. Ascites refers to collection of excess fluid in the peritoneal cavity. However, the exudatetransudate system of ascitic fluid classification has been replaced by the saag. The prognosis the life expectancy depends on the cause of ascities. It is recommended that the initial assessment should concentrate on history, examination, and basic tests on ascitic fluid to assess the serumascites albumin gradient. Ascitic fluid analysis diagnosing cause of fluid buildup in. Ascites does not typically become clinically detectable until there are at least 500mls of fluid present. With the patient supine, the examiner visually observes whether the flanks are pushed outward presumably by large amounts of ascitic fluid. Cap approved female reproductive ovary, fallopian tube, peritoneum 1. The fluid occurs as leakage from the veins and lymphatics into extravascular spaces. Serial measurement of weight also indicates fluid gain or loss. Peritoneal tuberculosis as a cause of ascites in a patient.
With the patient supine, the examiner visually observes whether the flanks are pushed. Serumascites albumin gradient saag can be cases and ascitic fluid was collected according to the used as a screening test in ascetic due to chronic liver size of the animal as per standard procedure rudloff, disease. In every newly diagnosed ascites, necessary investigations should be conducted by puncturing ascitic fluid. Second, combining cytologic examination sensitivity, 70% and cea determination sensitivity, 45% increased the sensitivity to 80%.
Pdf value of adenosine deaminase ada in ascitic fluid. Ascitic fluid represents a state of totalbody sodium and water excess. The most common clinical cause of ascitic fluid effusion as ascertained after examining 250 ascitic fluid specimens was liver cirrhosis 43. Ascitic fluid definition of ascitic fluid by medical dictionary. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. This clinical condition, in the absence of a decrease in the glomerular filtration rate, is known as pseudorenal failure. Protein ascitic fluid had been classified as an exudate if the total protein concentration is. Abdominal examination fluid thrill place the palm of your left hand against the left side of the abdomen flick a finger against the right side of the abdomen ask the patient to put the edge of a hand on the midline of the abdomen if a ripple is felt upon flicking we call it a fluid thrill ascites.
Pediatric ascites revisited balvir s tomar abstract ascites is the pathologic fluid accumulation within the peritoneal cavity. Preserve the patients privacy by draping the top of their body with the gown and below the waist with a sheet. Acute colonic pseudoobstruction ogilvies syndrome acute liver failure in adults. Ascitic fluid examination reviled clear watery acknowledgements transuded in all the dogs. Technically, it is more than 25 ml of fluid in the peritoneal cavity. Although the underlying cause of the ascites is often thought to be. In many cases it may be difficult to distinguish between obesity and small volume ascites. Paracentesis is performed in an area of dullness either in the. The concept of transudate versus exudate, as determined by total protein measurements, is outdated and the use of serum ascites albumin gradient as an. Aug 04, 2010 primary diagnosis of lymphomas from ascitic fluid is rare. Diagnosis and management of ascites this is a pdf version of the following document. Ascitic fluid analysis for the differentiation of malignancy. The ascites fluid analysis is done to ascertain where the exact root cause of a problem of ascites is originating from. The serumtoascites albumin gradient, calculated by subtracting the ascitic fluid.