IMAGING

Abdominal ultrasonography

• Highly sensitive and specific for ascites

• Non invasive

• May help guide location for paracentesis

• Imaging of choice since it is relatively cheap, and available, relatively safe

Abdominal CT note an increase in abdominal girth; however, abdominal tenderness is

found in only 40% of patients, and rebound tenderness is rare.

Most common bacteria is E. Coli.

• Bacteria are believed to gain access to peritoneum by hematogenous route.

Low ascitic fluid albumin (<1g/dl) predisposes SBP.

Abrupt onset of Fever, Chills, Generalized Abdominal Pain, Rebound Tenderness.

Ascitic Fluid analysis shows WBCs >500/mm3 and Neutrophils > 250/mm3.

• Useful in evaluation of intra-abdominal causes of ascites, such as hepatic vein

thrombosis or pancreatitis.

• Seldom done to rule out ascites because it is expensive, not readily available and
causes a lot of ionizing radiation.

DIAGNOSTIC PROCEDURES

Diagnostic paracentesis must be performed for the evaluation of all new cases of
ascites
Diagnostic laparoscopy may be indicated if malignant ascites is suspected

Right heart catheterization may be necessary to establish the diagnosis of constrictive

pericarditis.