It is fluid which is present in the abdominal cavity. The peritoneal cavity is a potential space lined by mesothelium of the visceral n parietal peritoneum.

1. Ms Ankita R Bhatiya
Assistant Professor
Shree P.M.Patel COLLEGE OF PARAMEDICAL
SCIENCE N TECHNOLOGY

2.  It include:
 1.What is Peritoneal fluid?
 2.Function of Peritoneal fluid.
 3.Collection of Peritoneal fluid.
 4. Examination of Peritoneal fluid.

3.  Introduction:
 It is fluid which is present in
the abdominal cavity.
 The peritoneal cavity is a potential
space lined by mesothelium of the
visceral n parietal peritoneum.

4.  Peritoneal fluid Formation:
 Peritoneal fluid is a selective ultra filtrate of
plasma.
 Small amount of the Peritoneal fluid is also
formed
from the cells lining the peritoneum and other
by capillaries.
 There is about 50-60 ml of peritoneal fluid at any
one time
and about 125 ml is generated every day.

5.  Composition of Peritoneal fluid:
o Volume: 50-60 ml
o Protein: up to 3 gm/dl
o Glucose: Same as plasma
o Amylase; Same as blood amylase
o BUN: similar to blood BUN
o WBC: <500/µL
o pH of 7.5 to 8
o LDH:70-140 U/L
o Alkaline phosphates: 20-90IU(For adult)
93-221 IU(For children)

6.  Function of Peritoneal fluid:
 Protection: It helps to protect the abdominal organ
from the sudden injury n damaged.
 Also acts as a medium for the transfer of substances
from the abdominal organ tissue to blood .
 Nutrition :
 Removal of waste :
 Lubrication :

7.  Collection of Peritoneal fluid:
 Paracentesis is a process by
which peritoneal fluid is collected.
 A needle is placed through the
skin and muscles of the abdominal wall into
the peritoneum space.

8. Procedure:
1.Take consent of a patient.
2.Position of patient: The patient is lied in supine
position over bed table.
3.Proper aseptic precautions are taken
with the help of spirit –iodine-spirit.
4.Before puncture give injection of atrophin
to prevent vasovagal shock.
5.Give xylocane injection as local anesthesia before puncture.

9. 6. Along with sonography the needle is inserted in to
abdominal space & allow the fluid to flow in
container.
7. Pleural fluid is collected in 3 tubes:
1. EDTA Bulb: Cell count n differential count.
2. Flouride Bulb: For glucose examination.
3. Plain Bulb: Chemical n immunology study

10.  Indication of Pleural fluid:
A) Transudate:
Increase hydrostatic pressure
Decreased plasma oncotic pressure
Congestive heart failure
Hepatic cirrhosis
Hypo proteinemia
B) Exudate:
Increased capillary permeability
Decrease lymphatic resumption
Primary bacterial peritonitis, Secondary bacterial peritonitis, TB
Neoplasm
Hematoma, Lymphoma
Metastatic carcinoma
Trauma, Pancreatitis, Bile peritonitis

11.  Examination of Peritoneal fluid:
1. Physical examination:
2. Chemical examination:
3. Microscopic examination:

12.  Physical examination of Peritoneal fluid:
1.Volume:
 Normally: 50 to 60 ml
 Transudates– 100 to 150 ml
Condition: Increase hydrostatic pressure
Decrease plasma oncotic pressure
Congestive heart failure
Hepatic cirrhosis, Hypoproteinemia
Exudates– More than 150 ml
Condition: Increased capillary permeability
Decrease lymphatic resumption
Primary bacterial peritonitis,Secondary bacterial peritonitis
TB, Neoplasm, Hematoma
Lymphoma, Metastatic carcinoma
Trauma, Pancreatitis ,Bile peritonitis

13. 2. color:
 Normally: colorless
 Transudates: Pale yellow or straw clr
 Exudates:
Reddish: Hemorrhagic pancreatitis, Rupture spleen, Liver,
Trauma, Malignancy, TB.
Green; Perforated intestine and gall bladder, Duodenal ulcer,
Cholecystitis, Acute pancreatitis, Appendicitis
Amber 0r yellow : Hepatic vein obstruction ,cirrhosis Nephritic
syndrome ,Congenital cardiac failure

14. 3.Appreance:
 Normally: Clear or transparent
 Transudate: Clear or transparent
 Exudate:
Turbid: Appendicitis, Pancreatitis, Infected intestine
Tuberculosis,
Cloudy: Bacterial Perotonititis, Primary bacterial infection,
Perforated bowel, Appendicitis, Pancreatitis.
Milky :Chylous effusion, Malignancy, Lymphoma, TB, Parasitic
infection, Hepatic cirrhosis

15. 4. Clot:
 Normally: absent
 Transudate: absent
 Exudate: Present
Tuberculous Peritonititis
5.Specific gravity:
 Transudate: below 1.010
 Exudate: above 1.010
Peritonititis ( Bacterial, Viral, Fungal)
Cancer
Pancreatitis

16.  Chemical examination of Peritoneal fluid:
1.Glucose:
 Normal range: 40-60 mg/dl
 Transudate: same as blood glucose
 Exudate: slightly reduce
 Method:
1.Visualised method
Benedict test
2.Colorimetric method
GOD-POD
 Condition for decrease glucose:
Bacterial ,Viral, Fungal Perotonititis
Pancreatitis
Tuberculosis Perotonititis
Cancer

17. 2. Protein:
 Normal range: 6-8gm/dl
 Transudate: below 3 gm/dl
 Exudate: Above 3 gm/dl
 Method:
1.Turbidometric method method
SSA
Heat n acetic acid
2.Colorimetric method
Biuret
 Condition for Increase protein:
Peritonititis(Bacterial, fungal,viral)
Tuberculosis

18.  Serum ascetic albumin gradient (SAAG)
 The serum ascetic albumin gradient (SAAG) indirectly
measures portal pressure and can be used to determine
if ascites is due to portal hypertension.
 SAAG calculation
 SAAG = (serum albumin) – (ascitic fluid albumin)
 Interpretation
 A high SAAG (>1.1g/dL) suggests the ascetic fluid is
a transudate.
 A low SAAG (<1.1g/dL) suggests the ascetic fluid is

19.  Causes of a high SAAG
 A high SAAG (i.e. transudate) suggests the presence
of portal hypertension, which may be caused by:
 Cirrhosis
 Hepatic failure
 Venous occlusion (e.g. Budd Chiari syndrome)
 Fulminant hepatic failure
 Alcoholic hepatitis
 Kwashiorkor malnutrition
 Causes of a low SAAG
 Causes of a low SAAG (i.e. exudate) include:
 Malignancy
 Infection
 Pancreatitis
 Nephrotic syndrome

20. 3. Amylase:
 Normal range: 30-110 IU
 Transudate: Normal
 Exudate: Above 110U IU
Condition: Acute Pancreatitis
Pancreatitis pseudo cyst
Trauma
Gastrointestinal duodenal perforation
Necrosis
Acute vein thrombosis
Non pancreatic malignancy

21. 4. Lactate dehydrogenate:
 Normal range: 140-280 U/L
 Transudate: NORMAL
 Exudate: Above 255 U/L
Method:
1.Colorimetric method
2. U.V.Kinetic method
 Condition for Increase protein:
Peritonititis (Bacterial, fungal,viral)
Tuberculosis
Malignancy

22. 5.Alkaline Phosphatase:
 Normal range: 20-90 IU (Adult)
93-221 IU (Children)
 Method:
1.Colorimetric method
P-nitrophenyl method(PNP Method)
 Transudate: NORMAL
 Exudate: Above 90 IU
Condition: Bone cancer
Hyperparathyroid
Spontaneous bacterial peritonititis

23. 6.Creatinine & Urea:
May differentiate between peritoneal fluid n urine.
Elevated serum urea level but normal creatinine suggest
bladder rupture.
7.Billirubin:
Normally:0.7 to 0.8 mg/dl
Billirubin level more then 6 mg/dl & ascitic fluid/serum
billirubin ratio over 1 suggests choleperitoneum from a
rupture gall bladder.

24. 8.Ph:
Normally: 7.4
Acidic: Hemorrhagic, Malignancy, Pancreatic ascities, Tb
peritonitis's
9.Lipid:
Cholesterol
Transudate: Below 46 gm/dl
Exudate: Above 46 gm/dl
Condition: Malignancy ,Hepatic cirrhosis

25. 10.Tumor marker:
CEA: Increase in gastric carcinoma

26.  Microscopic examination of peritoneal fluid:
1.TLC (Total leukocyte count):
 Normally: 0-50 cell/cumm
 Transudate: 0-50 cell/cumm
 Exudate: 50-500 cell
 Method: Same as Blood
 Condition in increase TLC count:
Bacterial, Viral Fungal (Peritonititis)
Primary bacterial peritonitis
Secondary bacterial peritonitis
TB
Neoplasm
Hematoma, Lymphoma
Metastatic carcinoma
Trauma, Pancreatitis, Bile peritonitis

27. 2. DC:
 Method: Same as Blood
 Neutrophilia:
Bacterial Peritonitis, Tuberculosis Peritonitis, Pancreatitis
Metastatic Tumor
 Lymphocytosis:
Viral Peritonitis, Tuberculosis
Malignancy
Rheumatoid peritonitis, SLE,Leukemia
 Eosinophilia:
Parasitic Infection
Chronic inflammatory process
Leukemia , Hypersensitivity reaction, Congestive heart failure

28. 3.Gram’s Stain:
 Normally: Bacteria absent
 Transudate: Bacteria absent
 Exudates: Bacteria present
 Clinical Condition: Bacterial Peritonititis, pancreatitis
Bacteria: Diplococci
Streptococcus
Pseudomonas
Neisseria
Homophiles influenza
4.AFB Stain:
 Normally: Bacteria absent
 Transudate: Bacteria present
 Exudates: Bacteria present
 Clinical Condition: Tuberculosis Peritonititis
 Bacteria: Mycobacterium Tuberculosis