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Liver & Ascites
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Laboratory & Imaging
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Laboratory & Imaging: Liver & Ascites
Laboratory: Examination of Peritoneal fluid
Analysis of ascitic fluid, unlike pleural fluid, generally requires few laboratory tests. Tests on ascitic fluid that are useful in the initial work-up of ascites of unknown etiology include:
| Gross Appearance |
|
| Cell Counts |
WBC with differential and PMN count RBCs |
| Albumin with calculation of the serum - ascites albumin gradient |
(see Differential Diagnosis for discussion of the albumin gradient utility in etiology) |
| Gram's stain and culture(bedside culture required) |
if tuberculosis is suspected, peritoneal biopsy of higher yield than tuberculosis smear and culture |
| Cytology |
|
| Note: For the patient with serial paracentesis procedures due to reaccumulation of fluid or for therapeutic indications, it may be necessary only to perform WBC, PMN, RBC counts and gram's stain and culture. SBP should always be suspected. |
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Tests that rarely help to clarify etiology of ascites:
- LDH
- Total protein
- Glucose
- Bilirubin
- Ascitic fluid pH
- CEA
Ultrasound/CT
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