Paracentesis; Risks & Complications of Paracentesis

Studies performed in ascitic fluid

Once the ascitic fluid is taken out, doctors will likely run a few tests to establish the cause of ascites and rule out an infection. They could perform the following exams:

Exams

• Cell count: This is an exam performed under the microscope. The purpose is to see what type of cells can be found in the ascitic fluid. It usually contains immune cells, but there’s an average threshold above which doctors can start to suspect an infection. This is a method to diagnose spontaneous bacterial peritonitis, a condition we have described above. A cell count is also helpful to detect hemorrhagic ascites if blood cells are found over a certain threshold level.
• Albumin determination: Albumin is a protein that should stay in the blood. It does not leak to the abdominal fluid. Thus, finding albumin in paracentesis fluid will help doctors diagnose the cause of ascites. It is used to determine the type of ascites and whether they come from portal hypertension.
• Gram stain and culture: Patients with an infection would also have bacteria and other microorganisms in this fluid, which is why gram stains and cultures are ordered. It is only required when an infection is very likely.
• Total protein: Besides albumin, we could also have other proteins in paracentesis fluid, and depending on the protein level, we can classify ascites into one or another type. It is particularly important in patients without portal hypertension, and high levels of total proteins are a sign of secondary peritonitis.

Additional Tests

• Amylase: This test will help doctors confirm a diagnosis of pancreatic ascites in patients with trauma or pancreatic disease.
• Triglycerides: A high level of triglycerides results in milky-colored fluid, which suggests that lymphatic fluid is draining into the abdominal cavity. It sometimes happens in patients with cirrhosis, but the most common causes include various types of cancer and infections such as tuberculosis.
• Cytology: It is mainly performed when cancer is a possibility or has been diagnosed previously. It is a practical test in the case of hepatocellular carcinoma.