Last reviewed: May 2020
Last updated: May  2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abdominal pain or tenderness
  • signs of ascites
  • fever
  • nausea/vomiting
  • diarrhoea
  • altered mental status
  • gastrointestinal bleed

Other diagnostic factors

  • hypothermia
  • hypotension
  • tachycardia

Risk factors

  • decompensated hepatic state (usually cirrhosis)
  • low ascitic protein/complement
  • gastrointestinal bleeding
  • endoscopic sclerotherapy for oesophageal varices
  • ascites due to malignancy, renal insufficiency, or congestive heart failure
  • extra-intestinal infection
  • invasive procedures

Diagnostic investigations

1st investigations to order

  • FBC
  • serum creatinine
  • ascitic fluid appearance
  • ascitic fluid absolute neutrophil count (ANC)
  • ascitic fluid Gram stain
  • ascitic fluid culture
  • blood cultures
  • LFT
  • PT/INR
More 1st investigations to order

Investigations to consider

  • highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid (Periscreen)
  • bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid
  • ascitic fluid pH and arterial blood pH
  • ascitic fluid protein, glucose, lactate dehydrogenase (LDH)
  • ascitic fluid carcinoembryonic antigen (CEA)
  • ascitic fluid alkaline phosphatase
  • CT scan abdomen
More investigations to consider

Emerging tests

  • ascitic fluid lactoferrin
  • ascitic fluid PCR for bacterial DNA
  • serum procalcitonin
More emerging tests

Treatment algorithm

Contributors

Associate Professor of Emergency Medicine

UCSF Fresno Medical Education Program

Fresno

CA

Disclosures

BC is an author of references cited in this topic.

Peer reviewersVIEW 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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