How are different types of ascites differentiated in paracentesis results?

Updated: Jul 05, 2018
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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An alternative way of differentiating ascites due to portal hypertension from that due to other causes is to measure ascitic fluid viscosity with a cutoff of 1.65. [4] Ascitic fluid viscosity has also been demonstrated to predict renal impairment in hepatic patients at a cutoff of 1.35 and a long intensive care unit (ICU) stay at a cutoff of 1.995.

A newer noninvasive method of differentiating exudative from transudative ascites by using B-mode gray-scale ultrasound histogram analysis has been described and appears to be effective. [5] In this method, the ascites–to–rectus abdominis muscle echogenicity ratio (ARAER) is measured. A value higher than 0.002 is regarded as exudative ascites, whereas a value lower than 0.002 is regarded as transudative ascites.

In patients with malignant ascites related to ovarian cancer, an ascites symptom mini-scale has been developed that serves as a simple and easy tool for assessment. [6] This scale includes five parameters: shortness of breath, distended abdomen, reduced mobility, fatigue, and loss of appetite. It can be used to identify patients with mild symptoms who may benefit from paracentesis.


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