Ascites Fluid Interpretation

Question 1

What is ascites?

Answer 1

Fluid collection in the peritoneal cavity which is most commonly secondary to portal hypertensions

Question 2

What are the different appearances of ascitic fluid and their differentials

Answer 2

Clear or straw coloured - liver cirrhosis
Cloudy - SBP, perfed bowel or pancreatitis
Bloody - Haemorrhagic pancreatitis or malignancy
Milk coloured - Lymphoma, TB or malignancy

Question 3

What is the white cell count in ascitic fluid which suggests infection?

Answer 3

> 250/ul. If predominantly neutrophils then think spontaneous bacterial peritonitis. If predominantly lymphocytes then think TB

Question 4

An elevated protein suggests?

Answer 4

SBP

Question 5

A low glucose suggests?

Answer 5

TB or Malignancy

Question 6

A high amylase suggests?

Answer 6

Pancreatitis

Question 7

What is the SAAG?

Answer 7

Serum ascitic albumin gradient. It can be used to determine whether ascites is due to portal hypertension. A high SAAG suggests fluid is transudate and is because of portal hypertension. A low saag suggests exudate (malignancy or infection)

Question 8

Different levels of LDH can tell you what?

Answer 8

High LDH suggests exudative fluid.
Low LDH suggests transudative fluid.