Author(s): McGibbon A, Chen GI, Peltekian KM, van Zanten SV
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Abstract The purpose of this study was to provide evidence-based approaches to detect ascites, perform paracentesis, order tests, and interpret the results. A Medline search was performed to identify relevant articles. Of 731 identified articles, 50 articles were used. The most sensitive findings for ascites detection are ankle edema (93\%), increased abdominal girth (87\%), flank dullness (84\%), and bulging flanks (81\%). Paracentesis is safe, with bleeding rates and leakage of <1\%. An ascitic fluid polymorphonuclear cell count >or=250 cells/mm(3) is the most sensitive test (86\%-100\%) to diagnose spontaneous bacterial peritonitis. The serum-ascites albumin gradient is the most useful test in identifying portal hypertension-related ascites. Large-volume paracentesis is effective in the treatment of refractory ascites. We conclude that paracentesis is a safe and vital procedure in patients with new-onset ascites. Once detected, an algorithmic approach to ordering tests and their interpretation is useful to determine etiology and direct further management.
This article was published in Dig Dis Sci
and referenced in Journal of Blood Disorders & Transfusion