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

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Answer

Answer

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)

Routine

Optional

Special

Cell count

Glucose (minimal use)

Cytology

Albumin

Lactate dehydrogenase

Tuberculosis smear and culture

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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