Approach to peritoneal fluid analysis
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Approach to peritoneal fluid analysis. From: Dr Yasir M Khayyat Assistant Professor ,Consultant Gastroenterologist Umm AlQura University. Pathophysiology of Cirrhotic Ascites. History in Ascites. Onset,progression,severity (breathing),precipitating and relieving factors

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Approach to peritoneal fluid analysis

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Approach to peritoneal fluid analysis

From:

Dr Yasir M Khayyat

Assistant Professor ,Consultant Gastroenterologist

Umm AlQura University


Pathophysiology of Cirrhotic Ascites

Khayyat ,Approach to peritoneal fluid analysis


Historyin Ascites

  • Onset,progression,severity (breathing),precipitating and relieving factors

  • Associated :fever, abdominal pain ,nausea,vomiting,jaundice

  • Liver disease history:viral,alcoholic,etc,or established cirrhosis

  • Previous Investigations or treatment

  • Sacral, Scrotal and lower limbs edema

  • Rule out other abdominal distension causes: Intestinal obstruction-Dilated bowel-Internal bleeding.

  • Identify PPT factors of Ascites: compliance,diet,other

Khayyat ,Approach to peritoneal fluid analysis


Physical Examination in Ascites

  • Vital signs:fever,tachycardia,tachpnea

  • General: Encephalopathy,Jaundice,resp distress

  • JVP: distension due to RHF

  • CVS:

  • RESP: pleural effusion

  • ABDOMEN:

    Inspection: everted umbilicus, flank fullness,striae

    Palpation:

    Percussion: [Flank dullness( if absent this means that there is < 10% chance of having Ascites) there is at least 1.5 liters of Ascites if dullness is present], shifting dullness, fluid thrill.

  • Lower Limbs: pitting edema

Khayyat ,Approach to peritoneal fluid analysis


Paracentesis Procedure

  • Indication: new onset Ascites in inpatient or outpatient .

  • Ascitic Tapping ( movie demonstration)

  • Prophylactic use of IV FFP or platelets is not needed before paracentesis.

  • 15 gauge needle 3.25 inch is better than 14 gauge is more successful in obtaining paracentesis.

Khayyat ,Approach to peritoneal fluid analysis


Ascitic fluid analysis panel

  • Cell count: differential ,PMN,% neutrophils on differential.

  • Chemistry: Albumin, total protein,LDH,glucose,amylase

  • SAAG : SerumAlbumin-AscitesAlbumin

  • Microbiology: gram stain, cultures ( aerobic and anaerobic),TB stain ( AFB)

  • Cytology:senstivity of 3 samples is better 96.7%

Khayyat ,Approach to peritoneal fluid analysis


Interpretation of Ascitic fluid infection findings

Khayyat ,Approach to peritoneal fluid analysis


Underlying cause of Ascites: The DD

Remember at least 4 causes each

Khayyat ,Approach to peritoneal fluid analysis


Treatment of Ascitic fluids Infection

5 days of IV antibiotics

5 days of IV antibiotics

5 days of IV antibiotics + anaerobic coverage ( metronidazole)

5 days of IV antibiotics

Khayyat ,Approach to peritoneal fluid analysis


Guidelines of Ascites treatment

Khayyat ,Approach to peritoneal fluid analysis


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