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Approach to peritoneal fluid analysis

Approach to peritoneal fluid analysis. From: Dr Yasir M Khayyat Assistant Professor ,Consultant Gastroenterologist Umm AlQura University. Pathophysiology of Cirrhotic Ascites. History in Ascites. Onset,progression,severity (breathing),precipitating and relieving factors

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Approach to peritoneal fluid analysis

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  1. Approach to peritoneal fluid analysis From: Dr Yasir M Khayyat Assistant Professor ,Consultant Gastroenterologist Umm AlQura University

  2. Pathophysiology of Cirrhotic Ascites Khayyat ,Approach to peritoneal fluid analysis

  3. Historyin Ascites • Onset,progression,severity (breathing),precipitating and relieving factors • Associated :fever, abdominal pain ,nausea,vomiting,jaundice • Liver disease history:viral,alcoholic,etc,or established cirrhosis • Previous Investigations or treatment • Sacral, Scrotal and lower limbs edema • Rule out other abdominal distension causes: Intestinal obstruction-Dilated bowel-Internal bleeding. • Identify PPT factors of Ascites: compliance,diet,other Khayyat ,Approach to peritoneal fluid analysis

  4. Physical Examination in Ascites • Vital signs:fever,tachycardia,tachpnea • General: Encephalopathy,Jaundice,resp distress • JVP: distension due to RHF • CVS: • RESP: pleural effusion • ABDOMEN: Inspection: everted umbilicus, flank fullness,striae Palpation: Percussion: [Flank dullness( if absent this means that there is < 10% chance of having Ascites) there is at least 1.5 liters of Ascites if dullness is present], shifting dullness, fluid thrill. • Lower Limbs: pitting edema Khayyat ,Approach to peritoneal fluid analysis

  5. Paracentesis Procedure • Indication: new onset Ascites in inpatient or outpatient . • Ascitic Tapping ( movie demonstration) • Prophylactic use of IV FFP or platelets is not needed before paracentesis. • 15 gauge needle 3.25 inch is better than 14 gauge is more successful in obtaining paracentesis. Khayyat ,Approach to peritoneal fluid analysis

  6. Ascitic fluid analysis panel • Cell count: differential ,PMN,% neutrophils on differential. • Chemistry: Albumin, total protein,LDH,glucose,amylase • SAAG : SerumAlbumin-AscitesAlbumin • Microbiology: gram stain, cultures ( aerobic and anaerobic),TB stain ( AFB) • Cytology:senstivity of 3 samples is better 96.7% Khayyat ,Approach to peritoneal fluid analysis

  7. Interpretation of Ascitic fluid infection findings Khayyat ,Approach to peritoneal fluid analysis

  8. Underlying cause of Ascites: The DD Remember at least 4 causes each Khayyat ,Approach to peritoneal fluid analysis

  9. Treatment of Ascitic fluids Infection 5 days of IV antibiotics 5 days of IV antibiotics 5 days of IV antibiotics + anaerobic coverage ( metronidazole) 5 days of IV antibiotics Khayyat ,Approach to peritoneal fluid analysis

  10. Guidelines of Ascites treatment Khayyat ,Approach to peritoneal fluid analysis

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