peritoneal analysis

1. Effusions peritoneal fluids:

2. • Peritoneal effusion, or ascites, is a collection of fluid in
the abdomen. This fluid collects in the lining of the
lower abdomen, which is called the peritoneum.
• With ascites, an abnormal amount of fluid builds up
between the two layers of the peritoneum.
• This fluid can put pressure on abdominal organs,
potentially causing pain, swelling and other symptoms.
• Based on severity, physicians classify peritoneal
effusion into three categories:
• Grade 1: The patient has a mild effusion, only
detectable by ultrasound.
• Grade 2: The patient has a moderate effusion, with
equal amounts of abdominal swelling (distension) on
each side of the abdomen.
• Grade 3: The patient has a large effusion, with marked
abdominal distension.

3. • Treatment may vary depending on the ascites
classification and cause. Often, the cause is cirrhosis of
the liver or cancer.
• If cancer is the cause, it is considered malignant
peritoneal effusion.
• This diagnosis has related treatment options to help
reduce fluid buildup and prevent it from recurring.
• Peritoneal Effusion and Mesothelioma
• Peritoneal effusion, or ascites, may be a symptom
of peritoneal mesothelioma. Some research shows
ascites in 60 – 100% of newly diagnosed peritoneal
mesothelioma patients. This symptom may be one of
the first things to make patients seek medical care.
• Doctors may classify peritoneal mesothelioma cases
based upon the presence of ascites. Patients can fall into
two general classifications:

4. • Dry painful type: Patients have abdominal pain due
to a large tumor in the abdomen.
• Wet type: Patients present with ascites and
increasing abdominal girth, not tumors.
• Diagnostic tests may help doctors diagnose patients
with ascites and, subsequently, peritoneal
mesothelioma. Once a patient is diagnosed
with mesothelioma, some treatments may seek to
resolve peritoneal effusions. These treatments may
help improve patients’ comfort and limit the
recurrence of ascites.

5. Mesothelioma

6. Causes of Peritoneal Effusion
• Multiple conditions may cause peritoneal effusion,
including mesothelioma and other cancers. Non-
malignant diseases related to abdominal organs
may also cause ascites.
• Peritoneal mesothelioma patients may develop
ascites from fluid produced by aggressive tumors.
This fluid accumulates in the abdominal cavity. If
cancer cells migrate to the lymphatic system, they
can block lymph drainage. This may also cause
ascites.

7. Peritoneal Effusion Causes
• Cancer, including mesothelioma
• Cirrhosis (liver disease)
• Dialysis
• Heart failure
• Pancreatic disease
• Tuberculosis

8. Symptoms of Peritoneal Effusion
• Peritoneal effusion may cause a range of symptoms,
including abdominal pain and nausea. For some patients, the
symptoms of ascites may be the first step towards another
diagnosis. Individuals should seek medical care for stomach
distention that feels full and painful.
• Symptoms of Malignant Peritoneal Effusion
• Abdominal pain
• Dyspnea (difficulty breathing)
• Fatigue
• Impaired movement
• Loss of appetite (anorexia)
• Lower limb swelling
• Nausea
• Vomiting

9. • Common peritoneal mesothelioma symptoms may
overlap with symptoms of ascites. Peritoneal
mesothelioma symptoms include weight loss, a full
abdomen, a general feeling of discomfort (malaise)
and abdominal discomfort. Malignant peritoneal
mesothelioma patients also report feeling overly full
and/or nauseous.
• As a patient’s underlying disease progresses,
symptoms such as ascites may worsen. This may
lead to increased abdominal discomfort. Talking
with a healthcare provider at the onset of symptoms
may help target the cause sooner. Some diseases,
such as mesothelioma and other cancers, are more
likely than others to lead to ascites.

10. Peritoneal Effusion Diagnosed:
• Diagnosing ascites is an important first step in pinpointing the underlying
condition. Doctors may use differential diagnosis to help rule out potential
causes.
• This process may include cytology testing to screen for cancer. The
diagnostic process may help doctors rule out other effusion-causing
cancers, such as ovarian cancer or breast cancer.
• A sample of fluid collected from the pericardial sac using a procedure called
a pericardiocentesis
• The diagnosis of malignant peritoneal effusion may include any
combination of the following:
• Abdominal paracentesis (removal of fluid) followed by ascitic fluid analysis
• Abdominal ultrasound
• Blood tests
• CT scan or other imaging tests
• Fluid biopsy
• Patient history
• Physical examination
• Tumor tissue biopsy

11. • If cancer has not already been diagnosed,
doctors may order a tumor tissue biopsy and
testing.
• This allows doctors to differentiate between
peritoneal effusion and malignant peritoneal
effusion.
• If diagnosed with mesothelioma, doctors may
classify patients by cell type and stage.
Depending on patients’ symptoms, doctors
may use various methods for treating ascites.

12. Peritoneal Effusion Treated:
• For patients, their mesothelioma cancer treatments may
also treat peritoneal effusions. Mesothelioma
doctors may also use other methods to manage
peritoneal effusion. Treatment methods for peritoneal
effusion include:
• Catheters and other drainage ports: Catheters are tubes
that can allow fluid to drain out of the peritoneum.
Some, such as shunts, can be implanted and used long-
term. Some catheters go through the skin, draining fluid
into an external container. Other catheters drain fluid
from the peritoneum into another area of the body.
Other types of drainage ports may also be used, such as
peritoneal ports.

13. • Diuretics: Doctors may prescribe medication that
increases the frequency of urination. This has shown a
reduction in peritoneal fluid buildup for some patients.
Diuretics may be more effective against ascites caused
by cirrhosis versus cancer.
• Hyperthermic intraperitoneal chemotherapy
(HIPEC): Doctors use a heated,
localized chemotherapy to treat peritoneal
mesothelioma in this method. The chemotherapy is
heated to a temperature that kills cancer cells without
killing healthy cells. Often HIPEC is combined
with cytoreductive surgery.
• Palliative HIPEC: This method uses heated
chemotherapy alone, not in combination with surgery.
For some patients, it has shown complete resolution of
ascites and improvement in quality of life.

14. • Paracentesis: In this method, doctors insert a needle into
the abdominal cavity to drain the fluid buildup in the
peritoneum. Paracentesis is the most common
treatment for malignant peritoneal effusion. It is
effective at relieving symptoms of abdominal
discomfort, nausea, vomiting and breathing difficulty.
This method provides temporary relief for 90% of
patients. Symptoms may return quickly, so this method
is frequently repeated.
• Diuretics and paracentesis are the most common first-
line treatments. These methods can help treat and
manage peritoneal effusions.
• Ascites may recur, resulting in patients receiving
routine rounds of drainage or other treatment. In some
of these cases, palliative care options may also help
ease discomfort.

15. Reported Improvements From At-
Home Drainage Treatment:
• Cognitive function
• Difficulty breathing
• Emotional function
• Fatigue
• Insomnia
• Loss of appetite
• Nausea and vomiting
• Pain
• Quality of life
• When managing peritoneal effusions and underlying diseases, early
detection, diagnosis and treatment matter. These factors may lead
to patients having different prognostic and treatment options.
Individuals experiencing symptoms of peritoneal effusion should
speak to a healthcare provider for further guidance.

16. Physical, Chemical:
• Transudate
• Most ascitic fluids are transudates and are caused by either
congestive heart failure or hepatic cirrhosis. Typical fluid
analysis results include:
• Physical characteristics—fluid generally appears clear or
straw-colored
• Protein—less than 3 g/dL
• Albumin level—low (typically evaluated as the difference
between serum albumin and peritoneal fluid albumin, termed
serum-ascites albumin gradient, or SAAG; values above 1.1
g/dL are considered evidence of a transudate.)
• Lactate dehydrogenase (LD) fluid/serum ratio—less than 0.6
• Glucose—equal to glucose level in the blood
• Cell count—few cells are present, usually lymphocytes
• Specific gravity—less than 1.015

17. Exudate
• Physical characteristics—fluid may appear cloudy
• Protein—greater than 3 g/dL
• Albumin level—higher than in transudates (typically
with a SAAG less than 1.1 g/dL)
• Lactate dehydrogenase (LD) fluid/serum ratio—
greater than 0.6
• Glucose—less than 60 mg/dL
• Cell count—increased
• Specific gravity—greater than 1.015

18. • Exudates can be caused by a variety of conditions and
diseases and usually require further testing to aid in the
diagnosis. Infections, trauma, various cancers, or
pancreatitis may cause exudates. The following is a list of
additional tests that a healthcare practitioner may order
depending on the suspected cause and typical results.
• Physical characteristics – the normal appearance of a
peritoneal fluid sample is usually straw-colored and clear.
Abnormal appearances may give clues to conditions or
diseases present and may include:
• Yellow with liver disease, milky from obstruction of the
lymphatic system, and greenish from bile
• Reddish peritoneal fluid may indicate the presence of blood,
most often due to trauma.
• Cloudy peritoneal fluid may indicate the presence of
microbes and/or white blood cells (WBCs), pointing to an
infection. It may also indicate lymph system blockage or
trauma.

19. Chemical tests – tests that may be
performed in addition to albumin may
include:
• Glucose—typically about the same as blood
glucose levels; may be lower with infection
• Amylase—increased with pancreatitis
• Tumor markers—to identify type of
malignancy

20. Microscopic :