Peritoneal Fluid Analysis:

• Increased accumulation:
  • Increased capillary permeability
  • Increased venous pressure
  • Decreased protein (oncotic pressure)
• Decreased clearance:
  • Increased lymphatic obstruction

Causes of ascities:

Transudative (<30 g/L ~ systemic disease)

• Liver (cirrhosis)
• Cardiac (RHF, constrictive pericarditis, etc.)
• Renal failure
• Hypoalbuminemia (nephrotic syndrome)

Exudative (>30 g/L ~ local disease)

• Malignancy
• Venous obstruction (Budd-Chiari)
• Pancreatitis
• Lymph obstruction
• Infection (especially TB)

SBP:

1. PMNs > 250 cells/mm3
2. + bacterial culture
3. Absence of secondary causes (i.e. bowel perforation, abscess, etc.)

SAAG:

• >1.1 g/dL ~ portal hypertension (97% accurate) => Transudative effusion
• <1.1 g/dL ~ absence of portal hypertension => Exudative effusion

Lymphocytic Ascities:

• Peritoneal carcinomatosis (>50% lymphocytes)
• Peritoneal TB (>70% lymphocytes)

Sister Mary Joseph’s Sign: hard periumbilica nodule ~ indicative of metastatic disease to abdomen – usually pelvic/GI primary.

Virchow’s Node: enlarged lymph node in the left supraclavicular fossa ~ indicates cancer in the abdomen.