Evaluation-ascites

Evaluation-ascites

(World J Hepatol 2013;5:251; JAMA 2016;316:340)

Figure:

• Physical exam: flank dullness (>1500 mL needed), shifting dullness (Se ~83%)
• Radiologic: U/S detects >100 mL fluid; MRI/CT (also help with Ddx)
  • Ultrasound is → used to → detect the presence of more than 100 milliliters of fluid, while Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans also help with differentiating the diagnosis and can be used as alternative options.
• Paracentesis: perform in all Pts w/ new ascites, suggested in all hosp. Pts w/ cirrhosis + ascites. Low complic. rate (~1% hematoma formation). Prophylactic FFP or plts does not ↓ bleeding complic. Most useful tests: cell count, alb, total protein (for SAAG), & culture

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• Serum-ascites albumin gradient (SAAG):
  • if SAAG > 1.1, then: check Ascites fluid total protein (AFTP)
    • if > 2.5, liver, else: heart
• Cell count of ascites

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Other tests

• amylase (pancreatitis, gut perforation)
• bilirubin (test in dark brown fluid, suggests bile leak or proximal intestinal perf);
• TG (chylous ascites);
• BNP (HF)
• cytology (peritoneal carcinomatosis, ~95% Se w/ 3 samples). SBP a/w ↓ glc & ↑ LDH.
• Ascites culture (prior to → abx if possible, should have both aerobic & anerobic w/ 10 cc per bottle)
• from: SAAG 󰒖