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  3. Ascitic Fluid Test

What is an ascitic fluid test?

Ascites is a condition characterised by accumulation of water in the abdomen. Ascitic fluid test checks this water for its characteristics and presence of various cells and proteins. Ascites commonly presents itself in individuals with cirrhosis, but can also be seen in various other non-liver-related conditions.

Ascites is identified with symptoms such as:

  • Bulging of the abdomen from sides
  • A feeling of fluid shifting in the abdomen           

An ultrasound exam may be done to confirm ascites. Once ascites is confirmed, it is important for the doctor to diagnose the underlying cause since the chances of survival in ascites that requires hospitalisation drop to around 85% at 1 year. Ascitic fluid test is one of the ways to diagnose the cause of accumulation of fluid.

In ascitic fluid test, the physical properties of the fluid are examined, for example, the colour, turbidity and presence or absence of blood. Physical exam of the fluid is followed by checking the fluid for levels of proteins like albumin, white blood cells, glucose, adenosine deaminase, amylase, bilirubin, etc.  Sometimes the ascitic fluid may also be tested for its pH, levels of lactate, presence of infections and tumour markers. If required, the doctor may also order for a gram stain test and a cell culture test.

  1. Why is ascitic fluid test performed?
  2. How do you prepare for an ascitic fluid test?
  3. How is ascitic fluid test performed?
  4. What do ascitic fluid test results mean?

Why is ascitic fluid test performed?

Ascitic fluid test is recommended in the following conditions:

  • Unexplained fever and abdomnial pain along with cirrhosis
  • To evaluate the presence of infections in a patient with cirrhosis
  • Encephalopathy in the presence of a cirrhotic liver condition
  • To check for the existence of internal injuries
  • To diagnose the cause of fluid accumulation in the abdomen

Ascites could be of different types and is caused due to dysfunction of various organs like liver, kidney, heart, pancreas and ovaries. Some cancers or infections are also responsible for the accumulation of fluid in the abdomen. Therefore, it becomes essential for the doctor to identify the exact cause of fluid accumulation. The levels of various substances in the fluid reflect the underlying condition. Therefore, ascitic fluid test is an essential part of ascites diagnosis.

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How do you prepare for an ascitic fluid test?

Ascitic fluid test does not need any special preparations. Individual undergoing this test must inform the doctor about any medical conditions they might have or any medications or herbal supplements that they are on. It is important to let the doctor know if women undergoing the test are pregnant. The doctor should also be given an accurate and detailed history of past medical conditions, as they may be the cause of ascites.

How is ascitic fluid test performed?

Test sample can be taken at any time of the day. The individual needs to visit the testing centre for this procedure. The doctor will ask the person to lie down on their back or side and will assess the abdomen to know the correct place from where the fluid should be taken. The point of insertion is in the line of the belly button, either on the left or on the right. Then the doctor will clean the area of puncture with a sterile solution and apply a numbing cream on it. They will aspirate about 50 mL of fluid from the abdomen using a sterile needle. The sample fluid is then sent to a laboratory for testing.

The individual might feel a slight tingling sensation and dizziness due to the numbing effect of the solution. So, it is best to have someone accompany them to the facility for the test.

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What do ascitic fluid test results mean?

Presence of ascitic fluid is an indication of an underlying condition and is usually associated with a poor prognosis. Assessment of the levels of various substances in the fluid will help the doctor evaluate the primary cause of fluid accumulation and order other tests as needed. The table given below relates the conditions associated with a change in the level of particular substances in ascitic fluid.

Substance Checked

Values

Associated Conditions

Polymorphonuclear leucocytes

≥250 cells/mm3

Spontaneous bacterial peritonitis (SBP)

Total leucocytes

≥500 cells/mm3

SBP

Lymphocytes

≥500 cells/mm3

Tuberculous peritonitis

Serum-ascites albumin gradient

>11 g/L

Portal hypertension, cardiac failure, cirrhosis and nephrotic syndrome
≤11 g/L

Malignancy, tuberculosis or pancreatitis

Total protein

<2.5 g/dL

Cirrhosis or nephrotic syndrome
>2.5 g/dL

Heart problems

Amylase

<2000 IU/L

Pancreatic ascites

Adenosine deaminase

36-40 IU/L

Tuberculous peritonitis

Glucose

<50 mg/dL

SBP

Lactate dehydrogenase

>225 mU/mL

SBP

In the case of spontaneous bacterial peritonitis, the doctor will order further tests to identify the type of bacterial infection present in the body.

The correlation between physical examination of ascitic fluid and the underlying conditions is given in the table below:

 
 

Physical Characteristics of the Fluid

Associated Conditions

Pale yellow

Sterile or normal (No infection)

Milky

Cirrhosis, lymphoma or thoracic duct injury

Turbid or cloudy

Infection present

Blood mixed in the fluid

Malignancy and abdominal trauma

Slightly red or pink

Injury at the site

Brown

Higher bilirubin content, gallbladder or biliary perforation

Some more tests may be required along with or after the ascitic fluid test to confirm the cause of fluid accumulation.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.                                          

References

  1. Hepatitis C online. Infectious Disease Education and Assessment. University of Washington and CD; Diagnosis and Management of Ascites
  2. Provan D, Oxford Handbook of Clinical and Laboratory Investigation. 4th ed. United Kingdom: Oxford University Press; 2018. Chapter 7, Gastroenterology; p.534.
  3. Garcia-Tsao G. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016. Chap 153, Cirrhosis and its sequelae.
  4. Runyon BA. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016. Chap 93, Ascites and spontaneous bacterial peritonitis.
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