What is the role of paracentesis in the evaluation of ascites in cirrhosis?

Updated: Oct 15, 2020
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Paracentesis is essential in determining whether ascites is caused by portal hypertension or by another process. Ascites studies also are used to rule out infection and malignancy. Paracentesis should be performed in all patients with either new onset of ascites or worsening ascites. Paracentesis also should be performed when SBP is suggested by the presence of abdominal pain, fever, leukocytosis, or worsening hepatic encephalopathy. Some argue that paracentesis should be performed in all patients with cirrhosis who have ascites at the time of hospitalization, given the significant possibility of asymptomatic SBP. (See Table 3, below.)

Table 3. Ascites Tests (Open Table in a new window)




Cell count

Glucose (minimal use)



Lactate dehydrogenase

Tuberculosis smear and culture


Gram stain

Triglycerides (to rule out chylous ascites)

Total protein


Bilirubin (to rule out biliary leak when clinically suspected)



Amylase (to rule out pancreatic duct leak when clinically suspected)

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