Evaluation of New Onset Ascites in a Patient with Chronic Hepatitis C

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A Perform a diagnostic abdominal paracentesis and obtain the following studies on the ascitic fluid: cell count and differential, total protein, albumin, and culture. In addition, calculate the serum-ascites albumin gradient (SAAG).

This answer is correct. A diagnostic abdominal paracentesis should be performed in all patients with new onset ascites. The ascitic fluid cell count and differential, total protein, and albumin, tests are the recommended tests to routinely perform on ascitic fluid. Calculating the serum-ascites albumin gradient (SAAG) is recommended and is essential to determine if the ascites is due to portal hypertension. In this patient, given the low-grade fever and abdominal pain, infected ascitic fluid is a concern.  Although the ascitic fluid cell count and differential will likely identify whether the ascitic fluid is infected, culture of ascitic fluid is indicated in an attempt to confirm infection and to identify the causative organism.  The yield on fluid culture is increased if the fluid is placed directly into a bacterial culture bottle.

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