Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain or tenderness
  • signs of ascites
  • fever
  • nausea/vomiting
  • diarrhea
  • altered mental status
  • GI bleed

Other diagnostic factors

  • hypothermia
  • hypotension
  • tachycardia

Risk factors

  • decompensated hepatic state (usually cirrhosis)
  • low ascitic protein/complement
  • GI bleeding
  • sclerosis of esophageal varices
  • malignant ascites
  • extraintestinal infection
  • invasive procedures

Diagnostic investigations

1st investigations to order

  • CBC
  • serum creatinine
  • ascitic fluid appearance
  • ascitic fluid absolute neutrophil count (ANC)
  • ascitic fluid Gram stain
  • ascitic fluid culture
  • leukocyte esterase reagent strip testing of ascitic fluid
  • blood cultures
  • LFT
  • prothrombin time/INR
  • ascitic fluid pH and arterial blood pH
Full details

Investigations to consider

  • ascitic fluid protein, glucose, lactate dehydrogenase (LDH)
  • ascitic fluid carcinoembryonic antigen (CEA)
  • ascitic fluid alkaline phosphatase
  • CT scan abdomen
Full details

Emerging tests

  • ascitic fluid lactoferrin
  • ascitic fluid highly sensitive leukocyte esterase reagent strip test
  • ascitic fluid granulocyte elastase (latex immunoassay test)
  • ascitic fluid PCR for bacterial DNA
  • short corticotropin stimulation test
  • serum procalcitonin
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor of Emergency Medicine

UCSF Fresno Medical Education Program

Fresno

CA

Disclosures

BC is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Visiting Hepatologist

Hepatic Hemodynamic Laboratory

Liver Unit

Hospital Clinic

Barcelona

Spain

Disclosures

ADG declares that he has no competing interests.

Associate Professor of Medicine

Program Director

Gastroenterology Fellowship Program

Medical College of Wisconsin

Milwaukee

WI

Disclosures

KS declares that he has no competing interests.

Assistant Professor of Medicine

Director

Yale Viral Hepatitis Program

Section of Digestive Diseases

Yale School of Medicine

New Haven

CT

Disclosures

JKL declares that he has no competing interests.

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