LABORATORY TESTS

Ascitic fluid evaluation includes

1. Inspection

Turbid fluid/Cloudy film - from infection or tumor cells within the fluid.

White, milky fluid - presence of triglycerides in levels >200 mg/dL (and often >1000
mg/dL), which is the hallmark of chylous ascites.

Bloody fluid - traumatic paracentesis or malignant ascites.

Mucinous fluid - pseudomyxoma peritonei, or, rarely, a colloid carcinoma of the

stomach or colon with peritoneal implants

Dark brown fluid - high bilirubin concentration and indicates biliary tract perforation.

2. Protein

Transudate (<25 g/l): seen nephrosis, congestive heart failure, cirrhosis; hepatic
sinusoids have been damaged and scarred and no longer allow passage of protein, as
occurs with cirrhosis, late Budd-Chiari syndrome, or massive liver metastases.

Exudated (>25 g/l): seen in neoplasm, tuberculous peritonitis, purulent pyogenic

peritonitis, pancreatic peritonitis; hepatic sinusoids are normal and allows passage of
protein into the ascites, as occurs in cardiac ascites, sinusoidal obstruction syndrome,
or early Budd-Chiari syndrome.

3. Albumin level

Compare with serum albumin level (SAAG)

4. Glucose level

Low in bacterial and tuberculosis peritonitis, pancreatic peritonitis