Ascites laboratory findings: Difference between revisions

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{{Ascites}}
{{Ascites}}


{{CMG}} {{AE}} {{MUT}}
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==Overview==
==Overview==


The only [[diagnostic]] [[laboratory]] finding associated with ascites is [[Serum-ascites albumin gradient|serum-ascites albumin gradient (SAAG)]]. [[SAAG]] is defined as the difference between [[albumin]] level in [[serum]] and ascites. Other [[diagnostic]] [[laboratory]] findings may reveal the underlying causes of ascites. Cirrhosis, as the most common cause of ascites, reveals elevated [[liver enzymes]], [[creatinine]], [[International normalized ratio|international normalized ratio (INR)]] along with decreased [[albumin]], [[platelet]] count, [[hemoglobin]] ([[anemia]]), and [[white blood cell (WBC) count]].
==Laboratory Findings==
* The only [[diagnostic]] [[laboratory]] finding associated with ascites is [[Serum-ascites albumin gradient|serum-ascites albumin gradient (SAAG)]].<ref name="pmid24292307">{{cite journal |vauthors=Uddin MS, Hoque MI, Islam MB, Uddin MK, Haq I, Mondol G, Tariquzzaman M |title=Serum-ascites albumin gradient in differential diagnosis of ascites |journal=Mymensingh Med J |volume=22 |issue=4 |pages=748–54 |year=2013 |pmid=24292307 |doi= |url=}}</ref>
** [[SAAG]] is defined as the difference between [[albumin]] level in [[serum]] and ascites.<ref>Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. ''Ann Intern Med'' 1992;117:215-20. PMID 1616215.</ref>
*** [[SAAG]] ≥ 1.1 g/dL reflects [[transudate]] ascites fluid.
*** [[SAAG]] < 1.1 g/dL reflects [[exudate]] ascites fluid.
* Other [[diagnostic]] [[laboratory]] findings may reveal the underlying causes of ascites.<ref name="OTM">Warrell DA, Cox TN, Firth JD, Benz ED. ''Oxford textbook of medicine''. Oxford: Oxford University Press, 2003. ISBN 0-19-262922-0.</ref>


==Laboratory Findings==
=== Cirrhosis ===
Routine [[complete blood count]] (CBC), basic metabolic profile, [[liver enzymes]], and [[coagulation]] should be performed.  Most experts recommend a diagnostic [[paracentesis]] be performed if the ascites is new or if the patient with ascites is being admitted to the hospital. The fluid is then reviewed for its gross appearance, protein level, [[serum albumin|albumin]], and cell counts (red and white). Additional tests will be performed if indicated such as [[Gram stain]] and [[cytology]].<ref name=OTM>Warrell DA, Cox TN, Firth JD, Benz ED. ''Oxford textbook of medicine''. Oxford: Oxford University Press, 2003. ISBN 0-19-262922-0.</ref>
* Elevated [[liver enzymes]] level
* Elevated [[creatinine]] level
* Elevated [[International normalized ratio|international normalized ratio (INR)]]
* Decreased [[albumin]] level
* Decreased [[platelet]] count
* Decreased [[hemoglobin]] ([[anemia]])
* Decreased [[white blood cell (WBC) count]]  


The ''[[Serum-ascites albumin gradient]]'' (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites.<ref>Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. ''Ann Intern Med'' 1992;117:215-20. PMID 1616215.</ref> A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive etiology.
=== Spontaneous bacterial peritonitis (SBP) ===
* Elevated [[white blood cell (WBC) count]]
* Decreased [[serum]] [[pH]] and [[bicarbonate]]
* Elevated [[Blood urea nitrogen|blood urea nitrogen (BUN)]]


[[Medical ultrasonography|Ultrasound]] investigation is often performed prior to attempts to remove fluid from the abdomen. This may reveal the size and shape of the abdominal organs, and Doppler studies may show the direction of flow in the portal vein, as well as detecting [[Budd-Chiari syndrome]] and [[portal vein thrombosis]]. Additionally, the sonographer can make an estimation of the amount of ascitic fluid, and difficult-to-drain ascites may be drained under ultrasound guidance. Abdominal [[CT scan]] is a more accurate alternate to reveal abdominal organ structure and morphology.
=== Chylous ascites ===
* Decreased [[serum]] [[albumin]] level
* Decreased [[serum]] [[gamma globulin]] levels
* Decreased [[lymphocyte]] count


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category: Medicine]]
[[Category: Up-To-Date]]
[[Category: Gastroenterology]]
[[Category: Hepatology]]
[[Category: Emergency medicine]]


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Latest revision as of 13:35, 26 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

The only diagnostic laboratory finding associated with ascites is serum-ascites albumin gradient (SAAG). SAAG is defined as the difference between albumin level in serum and ascites. Other diagnostic laboratory findings may reveal the underlying causes of ascites. Cirrhosis, as the most common cause of ascites, reveals elevated liver enzymes, creatinine, international normalized ratio (INR) along with decreased albumin, platelet count, hemoglobin (anemia), and white blood cell (WBC) count.

Laboratory Findings

Cirrhosis

Spontaneous bacterial peritonitis (SBP)

Chylous ascites

References

  1. ↑ Uddin MS, Hoque MI, Islam MB, Uddin MK, Haq I, Mondol G, Tariquzzaman M (2013). "Serum-ascites albumin gradient in differential diagnosis of ascites". Mymensingh Med J. 22 (4): 748–54. PMID 24292307.
  2. ↑ Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992;117:215-20. PMID 1616215.
  3. ↑ Warrell DA, Cox TN, Firth JD, Benz ED. Oxford textbook of medicine. Oxford: Oxford University Press, 2003. ISBN 0-19-262922-0.

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