Peritoneal examination


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Peritoneal examination

  1. 1. Peritoneal Fluid Examination Presented By: Nasir Nazeer
  2. 2. Peritoneal Fluid Peritoneal fluid is a liquid that is made in the abdominal cavity to lubricate the surface of the tissue that lines the abdominal wall, pelvic cavity and covers most of the organs in the abdomen. The peritoneal cavity is the space between the abdominal organs (such as the stomach, spleen, liver and gall bladder) and the membranes which line the wall of the abdomen. The peritoneal fluid is a clear, sterile fluid which is mostly water along with some white blood cells, antibodies, electrolytes and other bio-chemicals The main function of the peritoneal fluid is to ease friction caused by the movement of the abdominal organs, as they move around in the abdominal cavity.
  3. 3. Reasons for the tests Peritoneal fluid analysis is used to help diagnose the cause of peritoneal fluid accumulation (ascites) and/or inflammation of the peritoneum (peritonitis). There are two main reasons for fluid accumulation, and an initial set of tests (fluid albumin level, cell count and differential, and appearance) is used to differentiate between the two types of fluid that may be produced.  An imbalance between the pressure within blood vessels (which drives fluid out of the blood vessel) and the amount of protein in blood (which keeps fluid in the blood vessel) can result in accumulation of fluid (called a transudate). Transudates are most often caused by congestive heart failure or cirrhosis. If the fluid is determined to be a transudate, then usually no more tests on the fluid are necessary.
  4. 4. Reasons for the tests (Cotd..) Injury or inflammation of the peritoneum may cause abnormal collection of fluid (called an exudate) Exudates are associated with a variety of conditions and diseases, and several tests, in addition to the initial ones are performed and may be used to help diagnose the specific condition, including: Infectious diseases caused by viruses, bacteria, or fungi. Infections may originate in the peritoneum, due to a rupture of the appendix, perforation of the intestines or the abdominal wall, contamination during surgery, or may spread to the peritoneum from other places in the body. Inflammatory conditions – peritonitis due to certain chemicals, irradiation, rarely due to an autoimmune disorder Malignancies – such as mesothelioma, tumor of the liver (hepatoma), lymphoma, or metastatic cancer. Pancreatitis
  5. 5. Additional testing on exudate fluid may include: Peritoneal fluid glucose, amylase, tumor markers Microscopic examination – may be performed if infection or cancer is suspected. Laboratories may examine drops of the peritoneal fluid and/or use a special centrifuge (cyto-centrifuge) to concentrate the fluid's cells at the bottom of a test tube. Samples are placed on a slide, treated with a special stain, and an evaluation of the different kinds of cells present is performed. Gram stain – for direct observation of bacteria or fungi under a microscope Bacterial culture and susceptibility testing—ordered to detect any microorganisms, which will grow in the culture, and to guide antimicrobial therapy
  6. 6. When peritoneal fluid analysis is ordered? Peritoneal fluid analysis is ordered when a doctor suspects that a person has a condition or disease that is causing peritonitis and/or ascites. It may be ordered when someone has: Ascites of unknown origin Abdominal pain and tenderness Intestinal perforation Suspected intra-abdominal malignancy
  7. 7. How to Prepare Patient for the Test? Before drawing sample preliminary information should be collected from the patient.     Is patient taking any medications (including herbal remedies)? Patient having any allergies to medications or numbing medicine? Patient having any bleeding problems? Is patient pregnant or not?
  8. 8. Patient preparation before drawing sample Following procedure peritoneal fluid.      is adopted to draw Patient is directed to empty his bladder before undergoing the abdominal tap. A small section of the abdomen is cleaned with antiseptic. Local anesthesia is given to the patient. A needle is inserted to draw out the fluid. Patient may feel a pressure when the needle is being inserted. Patient might feel a little light-headed or dizzy if a large amount of fluid is extracted.
  9. 9. Peritoneal Fluid
  10. 10. Risks Involved There is a slight risk that the needle may puncture the bladder, bowel or a blood vessel. This can result in perforation and bleeding, or infection of the bowel. Ovarian and cervical cancers are the leading causes of cancer in women, leading to death. The progress of this disease is very insidious, because very often there are hardly any symptoms, and the cancer may be in a very advanced stage before it is discovered. Cytological examination of peritoneal fluid is very helpful in detecting the presence of cancer cells or other genetic abnormalities in ovarian and cervical cancer, at an early stage.
  11. 11. What does the test result mean? Test results can help to distinguish between types of peritoneal fluid and help to diagnose the cause of fluid accumulation. The initial set of tests performed on a sample of peritoneal fluid helps determine whether the fluid is a transudate or exudate.
  12. 12. What does the test result mean? Transudate fluid:     Ninety percent of ascitic fluids are Transudates and are caused by either congestive heart failure or cirrhosis. Typical fluid analysis results include: Physical characteristics—fluid appears clear 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.) Cell count—few cells are present
  13. 13. What does the test result mean? Exudate    Physical characteristics—fluid may appear cloudy Albumin level—higher than in transudates (typically with a SAAG less than 1.1 g/dL) Cell count—increased
  14. 14. Exudate fluid and tests Exudates can be caused by a variety of conditions and diseases and usually require further testing to aid in the diagnosis. Exudates may be caused by, for example, infections, trauma, various cancers, or pancreatitis. The following is a list of additional tests that the doctor may order depending on the suspected cause and typical results.     Physical characteristics – the normal appearance of a sample of peritoneal fluid 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. Cloudy peritoneal fluid may indicate the presence of microorganisms and/or white blood cells pointing to an infection.
  15. 15. Exudate fluid and tests (Contd..) Chemical 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
  16. 16. Exudate fluid and tests (Contd..) Microscopic examination – may be performed if infection or cancer is suspected. Normal peritoneal fluid has small numbers of white blood cells (WBCs) but no red blood cells (RBCs) or microorganisms. Results of an evaluation of the different kinds of cells present may include:    Total cell counts—WBCs and RBCs in the sample are enumerated. Increased WBCs may be seen with infections and malignant conditions. WBC differential—determination of percentages of different types of WBCs. An increased number of neutrophils may be seen with bacterial infections. Cytology – a cytocentrifuged sample is treated with a special stain and examined under a microscope for abnormal cells and for white cell differentiation. The differential can help determine whether the cells are the result of an infection or the presence of a tumor.
  17. 17. Exudate fluid and tests (Contd..) Infectious disease tests – tests may be performed to look for microorganisms if infection is suspected. Gram stain – for direct observation of bacteria or fungi under a microscope. There should be no organisms present in peritoneal fluid. Bacterial culture and susceptibility testing—If bacteria are present, susceptibility testing can be performed to guide antimicrobial therapy. If there are no microorganisms present, it does not rule out an infection; they may be present in small numbers or their growth may be inhibited because of prior antibiotic therapy. Less commonly, if testing for other infectious diseases is performed and is positive, then the cause of the peritoneal fluid accumulation may be due to a viral infection, mycobacteria (such as the mycobacterium that causes tuberculosis, or aparasite.