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Ascitic fluid may be used to help determine the etiology of ascites, as well as to evaluate for infection or presence of cancer. The SAAG is calculated by subtracting the albumin concentration of the ascitic fluid from the albumin concentration of a serum specimen obtained on the same day. The SAAG correlates directly with portal pressure. Transudative ascites occurs when a patient’s SAAG level is greater than or equal to 1. Exudative ascites occurs when patients have SAAG levels lower than 1. An alternative way of differentiating ascites due to portal hypertension from that due to other causes is to measure ascitic fluid viscosity with a cutoff of 1.
Ascitic fluid viscosity has also been demonstrated to predict renal impairment in hepatic patients at a cutoff of 1. A newer noninvasive method of differentiating exudative from transudative ascites by using B-mode gray-scale ultrasound histogram analysis has been described and appears to be effective. 002 is regarded as exudative ascites, whereas a value lower than 0. 002 is regarded as transudative ascites.
Spontaneous bacterial peritonitis Infection of ascitic fluid without intra-abdominal infection usually occurs in patients with chronic liver disease due to translocation of enteric bacteria. Patients whose ascitic fluid meets these criteria should be treated empirically, regardless of symptoms. Secondary bacterial peritonitis is defined as infected ascitic fluid associated with an intra-abdominal infection. A report by Lutz et al demonstrated that the relative PMN count, as compared with the absolute PMN count, is a less expensive marker associated with bacterascites and can be used to predict future episodes of SBP. This may be sueful for the purpsoes of risk stratification.
A report by Huang et al found that abdominal paracentesis drainage brought about clinical improvement in patients who had non-hypertriglyceridemia-induced severe acute pancreatitis with triglyceride elevation and pancreatitis-associated ascitic fluid. Large-volume paracentesis is often required in patients with refractory ascites. A report by Bureau et al described the use of a low-flow pump system that moves the fluid from the abdominal cavity into the bladder, from which it is removed via micturition. This was shown to improve patients’ quality of life and reduced the need for repeated large-volume paracentesis. Patients with an INR greater than 2. One strategy is to infuse one unit of fresh frozen plasma before the procedure and then perform the procedure while the second unit is infusing.
L should receive an infusion of platelets before the procedure. In these patients, pretreatment with FFP, platelets, or both before paracentesis is also probably not needed. A prospective study of 171 patients undergoing paracentesis found that “major” complications occurred in 1. Child-Pugh stage C, and patients with alcoholic cirrhosis. After proper antiseptic preparation and local anesthesia, a diagnostic tap can be performed with a 10- to 20-mL syringe and an 18-gauge needle. To minimize the risk of persistent leak from the puncture site, use a small-gauge needle or take a “Z” track during insertion of the needle.
During removal of the needle, the subcutaneous tissue seals on itself. In a retrospective review of 796 peritoneal fluid samples, the evaluation of Gram stain results rarely provided clinically useful information for the detection of SBP. Dietary sodium restriction and diuretics do not often provide symptomatic relief of refractory ascites in patients in advanced stages of cancer. Although paracentesis does effectively drain ascitic fluid, the condition invariably recurs, and repeated procedures are necessary. A 2008 study reported that a permanent peritoneal catheter to drain abdominal fluid greatly reduced the symptoms of ascites in these patients and avoided the costs and complications of frequent paracentesis procedures. A meta-analysis suggests that the use of albumin in cirrhotic patients undergoing paracentesis reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment.