Abstract
The abnormal accumulation of peritoneal fluid in the abdomen is a frequent complication in patients with cirrhotic and non-cirrhotic portal hypertension which is defined as ascites whose appearance heralds worsening of prognosis in such chronic diseases of the liver. Ascites can be also associated with acute liver failure, hepatic and extra-hepatic malignancies, infections (among them tuberculosis), pancreatitis, malnutrition or malabsorption or other rare inflammatory conditions. Therefore, peritoneal fluid analysis is mandatory to differentiate these clinical conditions in order to guide the best clinical management and treatment. This chapter summarizes the most important principles of peritoneal fluid analysis to best differentiate the etiological diagnosis of ascites.
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Exercises
Exercises
1.1 Case 1
Sixty-eight years old man, recent 5 kg weight gain and abdominal distension. In medical history: diabetes mellitus for 3 years, hypothyroidism treated, no history of liver disease.
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Blood Tests: AST 87 U/L; ALT 56 U/L; total bilirubin 1.4 mg/dL; albumin 3 g/dL; pCHE 1388 U/L, INR 1.31, creatinine 0.65 mg/dL. Anti HCV Ab positive, HCVRNA positive, normal TSH test.
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Abdominal US: Ascitic fluid, small-sized liver, no focal lesions, portal vein 17 mm, splenomegaly (15 cm).
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Diagnostic paracentesis:
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Clear fluid
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Liquid analysis: WBC 110/mm3, albumin 0.8 g/dL, total protein 1.1 g/dL, amylase 38 mg/dL, LDH 73 U/L, glucose 10 mg/dL ➔ SAAG 2.2 g/dL
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Aerobic and anaerobic fluid culture: negative
Diagnosis: ascites in previously unknown HCV-related cirrhosis.
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1.2 Case 2
Fifty-one years old woman, abdominal distension and pain. In medical history: breast cancer 8 years before (surgery, radiotherapy and chemotherapy).
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Blood Tests: AST 14 U/L; ALT 12 U/L; total bilirubin 0.2 mg/dL; albumin 3.9 g/dL; pCHE 6974 U/L, INR 1.03, creatinine 0.76 mg/dL. Anti HCV Ab negative; HBsAg negative, CA 15.3 1287 U/mL (<34 U/mL).
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Abdominal US: Ascitic fluid, regular liver, no focal lesions, portal vein 9 mm, spleen regular.
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Total body CT scan: lymphadenomegaly (chest and abdomen, diameter max 4 cm) abundant ascites, suspected peritoneal carcinomatosis
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Diagnostic paracentesis:
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Blood fluid
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Liquid analysis: WBC 192/mm3, albumin 3.1 g/dL, amylase 47 mg/dL, LDH 106 U/L ➔ SAAG 0.8 g/dL
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Aerobic and anaerobic fluid culture: negative
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Cytology: positive for atypical cell (suspected malignant cells)
Diagnosis: malignant ascites in metastatic breast cancer.
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Tosetti, G., La Mura, V. (2020). Peritoneal Fluid Analysis. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_37
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DOI: https://doi.org/10.1007/978-3-030-24432-3_37
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