Ascites
Biochemistry
| Normal range | Differentials | |
|---|---|---|
| Protein | 0.3-4g/dL | |
| Glucose | 7-10 | <6: TB, malignancy |
| Amylase | 50% serum | ↑ (x5 serum level): pancreatitis/pseudocyst/trauma, bowel strangulation |
| ALP | ↑: small bowel perforation/ strangulation |
Microscopy
| Normal range | Differentials | |
|---|---|---|
| RCC | None | >100/uL: malignancy, TB >100 000/uL: intra-abdominal trauma |
| WCC | <300/uL | >300/uL AND: >25% neutrophils: SBP, cirrhosis >25% lymphocytes: TB, chylous ascites mesothelial cells: TB peritonitis Gram + cocci: primary; Gram –ve: secondary |
SAAG = serum albumin - ascites albumin
| High (>1.1) SAAG | Low (<1.1) SAAG |
|---|---|
| TRANSUDATE = portal hypertension = LDH <225 U/L ➥ Cirrhosis ➥ Hepatic failure ➥ Cardiac ascites ➥ Venous occlusion e.g. Budd Chiari syndrome ➥ Alcoholic hepatitis ➥ Kwashiorkor malnutrition ➥ Fatty liver of pregnancy |
EXUDATE = inflammation/malignancy = LDH >225 U/L ➥ Malignancy ➥ Infection ➥ Pancreatitis ➥ Nephrotic syndrome ➥ Serositis (e.g. familial Mediterranean fever ⇒ recurrent polyserositis) ➥ TB peritonitis ➥ Biliary ascites |