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

• 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.

PARACENTESIS

Indications

• New

• Peritoneal dialysis patients with fever, abdominal pain or other signs of sepsis (

With initiation of dietary sodium restriction and diuretic therapy

• Aim for weight loss of no more than 0.5 kg/d in patients without edema
• Aim for weight loss of no more than 1.0 kg/d in patients with edema

• Inadequate response is defined as < 1 kg loss in the first 7 days and 2 kg loss
every 7 days thereafter

assessed regularly to monitor for complications of