Peritoneal Fluid Analysis


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Peritoneal Fluid Analysis

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Peritoneal Fluid Analysis

  1. 1. Peritoneal FluidAnalysis
  2. 2. Peritoneal Fluid Analysis• used to diagnose cause of peritoneal fluid accumulation (ascites) and/or inflammation of the peritoneum (peritonitis)1. initial tests:2. fluid albumin level3. cell count and differential4. appearance
  3. 3. fluid accumulate in the abdominalcavity1. imbalance of pressure within blood vessels VS. protein in blood  accumulation of fluid (transudate) (CHF/ cirrhosis)2. Injury/inflammation of the peritoneum cause abnormal collection of fluid (exudate).  results of: infection, malignancies (metastatic cancer, lymphoma, mesothelioma), or autoimmune disease.
  4. 4. Exudates are associated w/ diseases:• Infectious diseases: viruses, bacteria, or fungi.• Inflammatory conditions: peritonitis due to certain chemicals, irradiation & rarely autoimmune disorder• Malignancies: mesothelioma, hepatoma, lymphoma, or metastatic cancer• Pancreatitis
  5. 5. Additional tests on exudate fluid:• Peritoneal fluid glucose, amylase, tumor markers• Microscopic examination: if infection/cancer is suspected.• Gram stain – for bacteria or fungi• Bacterial culture and sensi: to detect any microorganisms and guide abx therapy• AFB smear & culture for viruses, mycobacteria & parasites
  6. 6. Cellno ‘standardized’ ascites fluid cell countGenerally accepted ‘cut-off’ for upper-limits of normal for infection is less than 250 PMNs/mm31. PMNs usually constitute 70% of the cell count. spontaneous bacterial peritonitis: PMN’s predominance2. tuberculous ascites: lymphocytic predominance.Bloody ascites fluid is usually the result of traumatic tap
  7. 7. • Peritoneal fluid analysis may be ordered when suspecting a condition or disease that is causing peritonitis or ascites.• It may be ordered when someone has:1. Ascites of unknown origin2. Abdominal pain and tenderness3. Intestinal perforation4. Suspected intra-abdominal malignancy
  8. 8. Exudates, Transudates and Ratios:We are always taught in medical school that the serum:ascites LDH and protein ratios : to differentiate exudates and transudatesThe literature shows that these calculations are actually not all that helpfulThe SAAG become more favored in helping to characterize ascites fluid.
  9. 9. Transudate• Physical characteristics: fluid is clear• Albumin level: low (typically evaluated as the difference between serum albumin and peritoneal fluid albumin (SAAG)• Values > 1.1 g/dL are considered evidence of a transudate• Cell count—few cells are present• <30g/L protein
  10. 10. Exudate• Physical characteristics—fluid appear cloudy• Albumin level—higher than in transudates (SAAG less than 1.1 g/dL)• Cell count—increased• >30g/L protein
  11. 11.  The Serum-Ascites Albumin Gradient: The concept surrounds oncotic-hydrostatic balance Simple calculation: Serum albumin – Ascites albumin= SAAG
  12. 12. Glucose:In uncomplicated ascites, usually similar to serum levels.In later SBP (but often not in early), ascites glucose levels can drop to as low as zero mg/dl secondary to bacterial consumption
  13. 13. Cultures and Gram Stains:Cultures should be obtained by inoculating blood culture bottles at the bedside to improve sensitivity to at least 80%, compared with 50% for ‘conventional’ culture methods.Gram stains are useless on ascites fluid – about as useful as asking for a Gram stain on blood cultures to look for bacteremia. The concentration of organisms just won’t be high enough to see something on Gram stain.
  14. 14. Cytologyhelpful only in diagnosing peritoneal carcinomatosis. sensitivities up to 100%.Does not detect most other intra-abdominal cancers because most of the cancers do not frequently metastasize to the peritoneum.Cytology helps only if you’re suspicious of a cancer that has spread to the peritoneumNegative cytology does not rule out cancers such as HCC or liver metastases, which commonly cause ‘malignant ascites.’