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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

Approach to peritoneal fluid analysis

From:

Dr Yasir M Khayyat

Assistant Professor ,Consultant Gastroenterologist

Umm AlQura University


Pathophysiology of cirrhotic ascites
Pathophysiology of Cirrhotic Ascites

Khayyat ,Approach to peritoneal fluid analysis


History in ascites
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
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
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
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
Interpretation of Ascitic fluid infection findings

Khayyat ,Approach to peritoneal fluid analysis


Underlying cause of ascites the dd
Underlying cause of Ascites: The DD

Remember at least 4 causes each

Khayyat ,Approach to peritoneal fluid analysis


Treatment of ascitic fluids infection
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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