Himali Meshram
● Blood investigations: Complete blood count, liver function tests, renal functional tests, plasma proteins

● Ascitic fluid examination-
White cell count: Ascitic fluid normally contains <500 leukocytes/ml and < 250 polymorphonuclear leukocytes/ml. A neutrophil count of > 250 cells/ml is highly suggestive of bacterial peritonitis. In tuberculous peritonitis and peritoneal carcinomatosis, there is predominance of lymphocytes.
Red blood count: RBC Count > 50,000/µl denotes hemorrhagic ascites, usually seen in malignancies, trauma or tuberculosis.
Total protein: Ascitic fluid is considered as an exudate if the protein level is more than or equal to 2.5 g/dl.
Triglycerides: A high level is suggestive of chylous ascites
Serum Ascites Albumin Gradient (SAAG): It is calculated as serum albumin - ascitic fluid albumin. SAAG > 1.1 g/dl is suggestive of portal hypertension and SAAG < 1.1 g/dl as non-portal hypertensive causes of ascites

● Imaging Studies
Chest and Plain Abdominal Films: Elevation of the diaphragm is seen in massive ascites. To be diagnosed on basis of radiographic films, > 500 ml of fluid is usually required.
Ultrasound: Abdominal ultrasound can be used to detect ascites even in morbidly obese patients. It is also useful in indicating appropriate site for paracentesis. It can detect as little as 100 ml of fluid in the peritoneal cavity.
CT and MRI: Small amounts of ascitic fluid such as in the perihepatic space, Morisons pouch, can be detected easily. Malignancies arising from abdominal organs can also be detected.

Ascites Ascites 10/02/2019
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