Gastro - Parancetesis Flashcards
(48 cards)
What is the peritoneum ?
The space between the visceral peritoneum and the parietal peritoneum
Membrane consists of capillaries and lymphatic vessels ( which allows the fluid to leak into that space)
If secretion is increased or reabsorption blocked-ascites
**if secretion is increase and more pearmeadle and leaky*
Indications for Paracentesis ?
Performed on cases of unexplained ascites to determine cause
Performed to relieve intra-abdominal pressure from the fluid
Paracentesis pre-procedure?
Obtain informed consent (written)
Pt should empty bladder before procedure
so we don’t puncture it
Measure abdominal girth - we wanna know how much fluid we are taking out
Obtain pt weight
Obtain baseline VS
Paracentesis procedure?
Use sterile technique
Anesthetize locally
Make small stab wound incision
A trocar, cannula, or catheter can be placed through the incision.
Plastic tubing is then connected to vacuum device or collection device
4L max removed at one time
**fluid in the abd push intestines up and posterior *
Paracentesis post-procedure?
Labs on the fluid should be performed immediately
Measure abdominal girth
Measure pt weight
Monitor VS (watch for hypotension)
Monitor serum protein and sodium levels
Albumin?? its a transport protein - might be abnormal because of lover disease
Transudate examples?
CHF
Chirrosis
Nephrotic Syndrome
hypoproteinemia
** happening from something or somewhere else *
Exudate examples?
Infection - SBP
Neoplasm
Less likey: pulmonary infarction, trauma, drug hypersensitivity
** happening right thee in the abd*
Paracentesis fluid Normal fluid color?
Normal: clear-light yellow, serous
Paracentesis milk-colored fluid color?
lymphoma, carcinoma , TB
Paracentesis cloudy/turbid color fluid?
Cloudy/turbid: peritonitis, pancreatitis, appendicitis
Paracentesis bloody color fluid?
Bloody: traumatic tap, hemorrhage, tumor
Paracentesis bile-stained fluid color?
Bile-stained: ruptured GB, acute pancreatitis, ruptured intestines
Paracentesis cell counts: RBC normal count?
none
if there is some then it indicates neoplasm, TB, bleeding
Paracentesis cell counts: WBC if transudate?
normal
Paracentesis cell counts: WBC if exudate?
Exudate = elevated, neutrophils ( cancers and infections)
Total protein fluid/serum ratio if transudate?
Transudates: <0.5
Total protein fluid/serum ratio if exudate?
Exudates: >0.5 ( 8/4 ration = 2) - high protein in fluid than serum
What is the most accurate way to differentiate between transudate vs. exudate?
Total protein fluid/serum ratio
Protein count if transudate?
Transudates: <3g/dL
Protein count if exudate?
Exudates: >3 g/dL - more protein in th fluid-
Usually glucose serum _______ peritoneal fluid levels?
equals
When will glucose be decreased?
Bacterial infections
SBP (spontaneous bacterial peritonitis)
b/c glucose being eaten up back bacteria
When is Amylase increased?
Pancreatic trauma
Pancreatic pseudocyst
Acute pancreatitis
Intestinal necrosis or perforation
**high amylase and concern for intestinal necrosis and they have ascites then at can further dx ywhat you thought it was /*
ammonia appears on paracentesis if?
Ruptured ulcer, appendix, intestine
**ammonia coming out of the bowel *
