Ascitic Fluid by Conventional method

Liver

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No Fasting Required

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Microscopic and chemical analysis of ascitic fluid.

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Ascitic Fluid by Conventional Method - Comprehensive Medical Test Guide

Why is it done?
- Test Purpose: Analyzes fluid accumulated in the peritoneal cavity (abdominal cavity) to diagnose the underlying cause of ascites and identify infections, malignancies, or metabolic disorders
- Primary Indications: Diagnosis of ascites etiology (cirrhosis, peritonitis, malignancy, heart failure, kidney disease, pancreatitis)
- Diagnostic Purposes: Detection of spontaneous bacterial peritonitis (SBP), detection of malignant cells, identification of infections (fungal, tuberculous), assessment of bleeding or coagulation disorders
- Therapeutic Indications: Paracentesis (fluid removal) for symptomatic relief of abdominal distension and respiratory compromise
- Typical Timing: Performed when ascites is first detected, with new onset ascites, with fever or abdominal pain in cirrhotic patients, or during hospitalization for complications
Normal Range
- Appearance: Clear to pale yellow
- Color: Colorless to pale yellow (if bloody or turbid, abnormal)
- Protein: <2.5 g/dL (Transudative fluid) or >2.5 g/dL (Exudative fluid)
- White Blood Cells (WBC): <500 cells/μL (Normal); >500 cells/μL (Abnormal); >250 PMN cells/μL suggests peritonitis
- Red Blood Cells (RBC): <5 cells/μL (Normal); >10,000 cells/μL (Suggests hemorrhage or malignancy)
- Glucose: >100 mg/dL (Normal); <50 mg/dL (Suggests bacterial infection or malignancy)
- LDH (Lactate Dehydrogenase): <200 IU/L (Normal); >200 IU/L (Exudative - suggests infection or malignancy)
- Albumin (Serum-Ascites Albumin Gradient - SAAG): <1.1 g/dL (Portal hypertension-related ascites); >1.1 g/dL (Non-portal causes)
- Bacteria Culture: No growth (Normal); Bacterial growth indicates infection
- Malignant Cells: None (Normal); Presence indicates malignancy
Interpretation
- Transudate vs Exudate Classification: Transudate (protein <2.5 g/dL) typically indicates portal hypertension, cirrhosis, heart failure, or kidney disease. Exudate (protein >2.5 g/dL) suggests infection, malignancy, pancreatitis, or tuberculosis
- Spontaneous Bacterial Peritonitis (SBP): Diagnosed when PMN count >250 cells/μL with positive culture or clinical symptoms. Requires immediate antibiotic therapy
- SAAG Interpretation: SAAG <1.1 g/dL indicates non-portal causes (malignancy, tuberculosis, peritonitis); SAAG >1.1 g/dL indicates portal hypertension-related ascites (cirrhosis, alcoholic hepatitis, massive liver metastases, Budd-Chiari syndrome)
- Appearance Abnormalities: Clear appearance is normal. Turbid appearance suggests infection. Bloody (hemorrhagic) appearance indicates malignancy, trauma, or bleeding disorder. Milky appearance suggests chylous ascites (lymphatic obstruction)
- Glucose Levels: Low glucose (<50 mg/dL) is concerning for bacterial peritonitis, tuberculous peritonitis, or malignancy. Must be compared with serum glucose level
- WBC Differential: Predominance of polymorphonuclear (PMN) cells suggests bacterial infection. Predominance of lymphocytes suggests tuberculosis or malignancy. Presence of eosinophils may indicate parasitic infection or malignancy
- Malignant Cell Detection: Positive findings indicate peritoneal carcinomatosis. Sensitivity of cytology varies (60-95%) depending on malignancy type and specimen quality
- Culture Results: Positive culture confirms bacterial, fungal, or tuberculous peritonitis. Negative culture does not exclude infection if clinical suspicion remains high
- Factors Affecting Results: Delay in processing can affect cell counts. Antibiotic use prior to culture may yield false negatives. Traumatic tap (blood contamination) may falsely elevate RBC and affect interpretation. Timing of paracentesis relative to symptoms impacts diagnostic yield
Associated Organs
- Primary Organ System: Peritoneal cavity, Liver, Gastrointestinal tract, Lymphatic system, Kidneys
- Liver-Related Conditions: Cirrhosis (most common cause - 81% of cases), alcoholic hepatitis, viral hepatitis, fatty liver disease, hepatocellular carcinoma, portal vein thrombosis, Budd-Chiari syndrome
- Cardiac Conditions: Congestive heart failure, constrictive pericarditis, restrictive cardiomyopathy, superior vena cava obstruction
- Malignant Conditions: Peritoneal carcinomatosis (ovarian, gastric, colon, pancreatic cancer), primary peritoneal cancer, peritoneal mesothelioma, hepatocellular carcinoma, metastatic cancers
- Infectious Conditions: Spontaneous bacterial peritonitis (SBP), tuberculous peritonitis, fungal peritonitis, secondary bacterial peritonitis (perforated viscus), peritoneal dialysis-related peritonitis
- Renal Conditions: Nephrotic syndrome, chronic kidney disease, peritoneal dialysis-related ascites, acute kidney injury with fluid overload
- Pancreatic Conditions: Acute pancreatitis, chronic pancreatitis, pancreatic cancer, pancreatic duct obstruction
- Vascular Conditions: Portal vein thrombosis, splenic vein thrombosis, hepatic vein thrombosis, mesenteric ischemia, abdominal aortic aneurysm rupture
- Other Conditions: Systemic lupus erythematosus (SLE), systemic sclerosis, lymphatic obstruction/chylous ascites, myxedema, peritonitis from various causes, bowel perforation, abdominal trauma
- Associated Complications: Spontaneous bacterial peritonitis (life-threatening), peritoneal bleeding, adhesions, bowel perforation, hepatorenal syndrome, sepsis, hypoalbuminemia, electrolyte abnormalities, respiratory compromise from abdominal distension
Follow-up Tests
- Based on High PMN Count (>250 cells/μL): Blood cultures, Gram stain and culture, Broad-spectrum antibiotic initiation, Repeat paracentesis after 48 hours, Serum creatinine and bilirubin, Hepatology consultation
- Based on Suspected Malignancy: Repeat ascitic fluid cytology (if initially negative, 25-50% of malignancies missed on first tap), Tumor markers (AFP, CEA, CA-125), CT abdomen/pelvis with contrast, Imaging-guided biopsy if indicated, Oncology referral
- Based on Lymphocytic Predominance: AFB smear and culture (tuberculosis), Adenosine deaminase (ADA) level, TB PCR/molecular tests, Chest X-ray, Tuberculin skin test (TST), TB prophylaxis consultation if indicated
- Based on High Protein/Exudative Results: Lipase (pancreatitis), Amylase, Liver function tests, Bilirubin, Prothrombin time, Ultrasound abdomen, CT abdomen/pelvis
- Based on Hemorrhagic Fluid (RBC >10,000): Coagulation profile (PT/INR, aPTT), Platelet count, Fibrinogen, Hemoglobin/hematocrit, Imaging to rule out malignancy or bleeding source, Angiography if vascular injury suspected
- Imaging Follow-up: Ultrasound abdomen/pelvis (assess liver structure, portal vein patency, spleen size), CT abdomen/pelvis with IV contrast (characterize ascites, identify underlying pathology), MRI MRCP if biliary obstruction suspected
- Liver Function Tests: ALT, AST, alkaline phosphatase, bilirubin, albumin, prothrombin time, platelet count (Child-Pugh score calculation)
- Serum-Ascites Tests: SAAG calculation (serum albumin minus ascitic albumin), Protein ratio determination, Comparison with serum values
- Monitoring Frequency: Cirrhotic patients with ascites: Annual paracentesis if not being treated; Monthly if treated with diuretics; Immediately if fever, abdominal pain, or deterioration occurs. Malignancy patients: Repeat cytology if suspicion high. Infection: Repeat after 48 hours of antibiotics if SBP suspected
Fasting Required?
- Fasting Requirement: NO - Fasting is NOT required for ascitic fluid collection by paracentesis
- Patient Preparation: Patient may eat and drink normally before the procedure. Routine meals should not be restricted. Adequate hydration is actually beneficial
- Medication Instructions: Continue all routine medications unless specifically instructed otherwise. Blood thinners (warfarin, DOACs): Discuss with physician prior to procedure - may need temporary discontinuation. Aspirin: Generally safe to continue but report to provider. NSAIDs: May be held 3-5 days before procedure. Antibiotics: Do not discontinue before culture collection
- Pre-Procedure Preparation: Empty bladder and bowels prior to paracentesis. Wear comfortable, loose-fitting clothing. Remove all jewelry from abdomen area. Arrive 15 minutes early for vital signs assessment. Discuss any allergies (especially iodine or local anesthetics). Informed consent must be obtained. Lab work (CBC, PT/INR, platelet count) may be required before procedure
- Post-Procedure Instructions: Rest for 1-2 hours after procedure. May resume normal diet immediately unless otherwise instructed. Stay hydrated with fluids. Monitor puncture site for bleeding, excessive drainage, or infection. Report fever, severe abdominal pain, or signs of peritonitis. Avoid strenuous activity for 24-48 hours. Dressing over puncture site may be removed after 24 hours
- Contraindications/Precautions: Uncorrected coagulopathy or thrombocytopenia <50,000/μL. Active abdominal wall infection or skin lesions at puncture site. Pregnancy (relative contraindication). Surgical scars or altered anatomy at proposed puncture site. Bowel distension or intestinal obstruction. Loculated ascites requiring imaging guidance. Recent anticoagulation therapy may require reversal. Hemodynamic instability requires stabilization
- Specimen Handling: Ascitic fluid must be processed promptly (ideally within 1 hour). For culture: Use sterile tubes and inoculate blood culture bottles at bedside. For cell count: Use EDTA tube (purple top). For chemistry (glucose, protein, LDH): Use plain or gel separator tubes. For cytology: Use formalin-fixed containers. Gentle handling prevents cell lysis. Refrigerate if delay expected
- Clinical Documentation: Procedure date and time. Volume of fluid collected. Gross appearance (color, clarity, odor). Complications during procedure. Needle size and puncture site. Clinical indication for procedure. Patient tolerance of procedure. Prior antibiotic administration. Culture bottle inoculation method

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