Ascites I Fluid in Abdominal Cavity

What is Ascites?

Ascites is a condition in which fluid collects in spaces within your abdomen. If severe, ascites may be painful. The problem may keep you from moving around comfortably. Ascites can set the stage for an infection in your abdomen. Fluid may also move into your chest and surround your lungs. This makes it hard to breathe.

Indications for Ascitic Fluid Tap (Abdominal Paracentesis)

• To aid diagnosis of the cause of ascites or in the diagnosis or exclusion of SBP
  • A diagnostic paracentesis should be performed in all patients with new onset grade 2 or 3 ascites, and in all patients hospitalized for worsening of ascites or any complication of cirrhosis

Samples in paracentesis

• Microbiology
  • Microscopy, culture & sensitivities (be explicit if yeast or mycobacterium suspected)
  • Culture in blood culture bottles inoculated at the bedside
• Hematology
  • Automated WCC count (send EDTA sample)
• Biochemistry
  • Albumin, Protein, LDH, Glucose
  • Remember to send a serum albumin, LDH and glucose at the same time (or at least from the same day).
  • Special tests: Fluid amylase,  Triglycerides, Bilirubin
• Cytology
  • Sent the largest sample
• Samples can also be sent for immunology (RF, ANA) and TB culture if clinically indicated

Contraindications to ascitic tap (paracentesis)

• Overlying infection
  • Chose another site
• Cautions – but not contraindications
  • Coagulopathy (INR>2.0)
    • Attempt to correct INR to <1.5 if possible.
  • Platelets<50
    • Thrombocytopenia and coagulopathy is often present in liver disease and though it is a caution, it not a contraindication to paracentesis or drainage
    • The incidence of clinically significant bleeding is low; routine FFP or platelets is not indicated
  • Pregnancy
  • Organomegaly
  • Obstruction/ileus
  • Distended bladder
  • Abdominal adhesions