Peritoneal washings by Conventional method

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Cytology of peritoneal fluid.

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Peritoneal Washings by Conventional Method - Comprehensive Medical Guide

Why is it done?
- Test Purpose: Peritoneal washings (also called peritoneal lavage) is a diagnostic procedure that collects fluid from the peritoneal cavity using a conventional method. The collected fluid is analyzed via light microscopy to detect the presence of malignant cells, bacteria, inflammatory cells, and other abnormalities within the abdominal cavity.
- Primary Indications: Detection of peritoneal malignancies (ovarian, endometrial, gastric, pancreatic, and colorectal cancers); Diagnosis of peritonitis and abdominal infections; Evaluation of ascites of unknown etiology; Assessment for abdominal trauma complications; Detection of tuberculosis or fungal infections in the peritoneal cavity; Staging of known malignancies
- Timing and Circumstances: Performed when imaging studies reveal ascites; During diagnostic laparoscopy or laparotomy for suspected malignancy; When patients present with unexplained abdominal distention; During follow-up for known intra-abdominal malignancies; When there is clinical suspicion of peritoneal involvement by cancer
Normal Range
- Normal/Negative Results: No malignant cells present; No bacteria or evidence of infection; Absence of atypical or suspicious cells; Clear fluid with minimal cellular debris
- Cell Count Ranges: Total cell count: Less than 300 cells/μL (normal peritoneal fluid is typically acellular or has minimal cells); Red blood cells: 0-10 cells/μL; White blood cells: 0-300 cells/μL (predominantly lymphocytes and macrophages); Lymphocytes: 50-70% of total white cells; Mesothelial cells: 10-30% of total white cells
- Interpretation of Normal vs. Abnormal: Normal: Negative for malignancy (negative cytology), negative for microorganisms, low inflammatory cell count, absence of atypical mesothelial cells; Abnormal: Positive for malignant cells indicates peritoneal involvement by cancer, positive for bacteria/fungi indicates infection, elevated inflammatory cells suggest peritonitis, atypical cellular changes require correlation with clinical findings
- Units of Measurement: Cells/μL (cells per microliter); Percentage of total white cell count (%); Morphologic descriptions for cell types; Microorganism identification and culture results
Interpretation
- Positive for Malignant Cells: Indicates peritoneal carcinomatosis or metastatic disease within the abdominal cavity; Confirms peritoneal involvement by malignancy; Changes cancer staging from M0 to M1 (metastatic disease); Important for treatment planning and prognosis determination; Identifies disseminated malignancy
- Elevated White Blood Cells: Greater than 300 cells/μL suggests inflammation; Lymphocyte predominance indicates viral infection, tuberculosis, or chronic peritonitis; Neutrophil predominance suggests acute bacterial peritonitis; Eosinophilia may indicate parasitic infection or peritoneal dialysis
- Positive for Bacteria or Microorganisms: Confirms bacterial peritonitis; May indicate specific organisms (gram-positive, gram-negative, anaerobes); Positive culture identifies causative organism and allows antibiotic sensitivity testing; Suggests need for immediate antimicrobial therapy
- Elevated Red Blood Cells: May indicate traumatic tap or abdominal bleeding; Significant RBC elevation suggests intra-abdominal hemorrhage; Helps evaluate for trauma complications
- Atypical or Reactive Mesothelial Cells: Non-specific finding that may occur with inflammation, infection, or irritation; Must be distinguished from malignant cells; May require correlation with clinical history; Sometimes warrants repeat sampling or immunohistochemistry for confirmation
- Factors Affecting Results: Specimen quality and adequacy; Timing of collection relative to disease progression; Presence of ascites volume affecting cell concentration; Contamination during collection; Cellularity variations in different peritoneal areas; Prior chemotherapy or radiation effects on cell morphology; Technical processing and staining methods
- Clinical Significance of Result Patterns: Malignant cytology findings carry high specificity for malignancy but moderate sensitivity (60-80%); Negative findings do not completely exclude malignancy; Serial sampling may increase detection rate; Combined with imaging and clinical evaluation for optimal diagnostic accuracy
Associated Organs
- Primary Organ Systems Involved: Peritoneal membrane and cavity; Intra-abdominal organs (ovaries, uterus, stomach, pancreas, colon, liver, small intestine); Lymphatic system; Gastrointestinal tract; Reproductive system (in females)
- Malignancies Commonly Associated with Abnormal Results: Epithelial ovarian cancer (most common); Endometrial cancer; Gastric adenocarcinoma; Pancreatic cancer; Colorectal cancer; Peritoneal mesothelioma; Primary peritoneal carcinoma; Appendiceal mucinous neoplasms; Hepatocellular carcinoma with peritoneal spread; Breast cancer with peritoneal involvement
- Non-Malignant Conditions Associated with Abnormal Results: Peritonitis (bacterial, tuberculous, fungal); Spontaneous bacterial peritonitis; Secondary bacterial peritonitis; Peritoneal dialysis-related infections; Cirrhosis-related ascites; Peritoneal tuberculosis; Fungal peritonitis; Intra-abdominal abscess; Inflammatory peritoneal disease
- Diagnostic Conditions This Test Helps Identify: Stage III and IV epithelial ovarian cancer; Peritoneal carcinomatosis; Cancer staging and stratification; Peritoneal involvement assessment; Infection type and organism identification; Ascites etiology determination; Abdominal trauma complications; Treatment response monitoring
- Potential Complications and Risks Associated with Abnormal Results: Malignant findings indicate advanced disease with poor prognosis; Positive peritoneal cytology necessitates aggressive treatment; Peritonitis associated with high mortality if untreated; Bacterial peritonitis can progress to sepsis and organ failure; Tuberculous peritonitis risk of chronic abdominal complications; Delay in diagnosis increases peritoneal disease burden; Risk of peritoneal adhesions; Potential for recurrent ascites accumulation
Follow-up Tests
- Tests Recommended for Positive Malignant Cytology: Immunohistochemistry (IHC) for cell classification and origin determination; Tumor markers (CA-125 for ovarian/peritoneal cancer, CEA for gastrointestinal malignancies, CA 19-9 for pancreatic cancer); Imaging studies: CT abdomen/pelvis, MRI, or PET-CT for staging; Molecular testing for treatment selection; Histopathology if tissue is available; Additional laparoscopy for tumor debulking assessment
- Tests Recommended for Positive Infection: Culture and sensitivity testing for antibiotic selection; Gram stain interpretation; Acid-fast bacilli (AFB) stain for tuberculosis; Fungal culture if fungal infection suspected; Blood cultures for systemic infection assessment; Inflammatory markers (ESR, CRP); Abdominal imaging for complications; Repeat paracentesis to assess treatment response
- Tests Recommended for Atypical or Borderline Findings: Repeat peritoneal washings/cytology; Flow cytometry for cell type characterization; Special stains (PAS, GMS, AFB); Electron microscopy if available; Repeat imaging studies; Clinical follow-up with reassessment; Tumor markers if cancer suspected
- Further Investigations Based on Results: Exploratory laparotomy or diagnostic laparoscopy for tissue confirmation; Cross-sectional imaging (CT/MRI) for disease extent assessment; Endoscopy if upper or lower GI malignancy suspected; Colonoscopy for colorectal cancer screening; Upper GI endoscopy for gastric/esophageal lesions; Liver biopsy if hepatic involvement; Peritoneal biopsy under direct visualization
- Monitoring Frequency for Ongoing Conditions: For treated peritonitis: Clinical assessment every 48-72 hours; Repeat paracentesis if no clinical improvement; For malignancy: Tumor markers every 3-6 months; Imaging studies annually or as clinically indicated; Clinical assessment every 1-3 months; More frequent monitoring during active treatment; For peritoneal dialysis patients: Regular cell count monitoring with each exchange; Culture every 3-6 months or if symptomatic
- Related Tests Providing Complementary Information: Serum tumor markers (CA-125, CEA, CA 19-9); Complete blood count (CBC); Comprehensive metabolic panel; Lactate dehydrogenase (LDH); Albumin and protein levels; Peritoneal fluid chemistry (glucose, protein, LDH); Acid-base status; Blood cultures; Prothrombin time (PT/INR); Imaging correlation (ultrasound, CT, MRI)
Fasting Required?
- Fasting Requirement: No fasting required
- Pre-Procedure Preparation: Patient may eat and drink normally on the day of the procedure (unless general anesthesia is planned); Full bladder may be helpful for ultrasound guidance (drink 1-2 glasses of water 1 hour before); Empty bowels if possible to improve visualization; Avoid strenuous activity for 24 hours before procedure
- Medications to Avoid: Anticoagulants (warfarin, apixaban, etc.): Discuss with physician; may need temporary discontinuation; Antiplatelet agents (aspirin, clopidogrel): May need to be stopped 3-5 days before procedure; NSAIDs: Avoid for 7-10 days before procedure; Inform physician of all medications prior to procedure; Note: Specific medication adjustments depend on the clinical setting and whether laparoscopy or other surgical intervention accompanies the washings
- Additional Patient Preparation Requirements: Sign informed consent form; Disclose allergies (especially to iodine or local anesthetics); Empty bladder immediately before procedure; Disrobe from waist down and wear hospital gown; Remove all jewelry and metal objects; Disclose any prior abdominal surgeries; Inform of history of peritonitis or adhesions; Arrange transportation home if conscious sedation planned; Inform about post-procedure care and activity restrictions; Pregnancy test if of childbearing age and unknown pregnancy status
- Post-Procedure Instructions: Avoid strenuous activity for 24-48 hours; Avoid heavy lifting (nothing heavier than 10 lbs) for 1 week; May resume normal diet after procedure; Monitor for fever, signs of infection, or unusual bleeding; Keep incision clean and dry; Report any severe abdominal pain, persistent vaginal bleeding, or fever above 101°F; Results typically available within 24-72 hours; Follow-up appointment should be scheduled with physician

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