Evaluation of New Onset Ascites in a Patient with Chronic Hepatitis C
This answer is incorrect. A diagnostic abdominal paracentesis should be performed in all patients with new onset ascites. Although testing for ascitic fluid cell count and differential, protein, albumin, and calculation of the serum-ascites albumin gradient (SAAG) are appropriate initial tests for evaluate new onset ascites, the cancer antigen CA 125 should not be measured in ascites fluid. It is elevated in essentially all patients with ascites. Checking CA 125 in women is especially problematic in this setting, since an elevated CA 125 will lead to unnecessary gynecologic evaluation looking for ovarian cancer. In addition, considering the patient’s fever, culture is indicated to evaluate for spontaneous bacterial peritonitis and to identify the causative organism if infection is present.
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