Skip to main content

Analysis of ascitic fluid in cirrhosis

Abstract

In order to determine the composition of “normal” ascitic fluid, the results of analysis of the first paracentesis on 347 consecutive cirrhotic patients with ascites at the West Haven Veterans Administration Hospital between 1955 and 1976 were examined. The ascites was considered “normal” in 259 patients. Bacterial peritonitis was present in 51, malignant ascites in 18, pancreatitic ascites in 15, and ascites of other types in 4 patients. Normal ascites is sterile, usually clear, and contains 281±25 leukocytes/mm3 (mean±Sem), 27±2% of which are polymorphonuclear. Inspontaneous bacterial peritonitis the fluid is usually cloudy, contains 6084±858 white blood cells/mm3, 77±4% of which were PMN and culture is positive for a single bacterial species, usually enteric in origin.Malignant andpancreatitis ascites are sterile, often cloudy, and contain an average of 696±273 and 1821±833 leukocytes/mm3, respectively, about half of which are polymorphonuclear. Amylase activity is increased in pancreatitic ascites, but not in other types of ascites. Stained smears of sediment for bacteria are often positive in bacterial peritonitis, but not in the other categories. Neither the specific gravity, protein concentration, nor glucose level is useful in the differential diagnosis of ascites. Based on the critical number of leukocytes alone, (500/mm3), one can accurately differentiate infected from uninfected fluid in over 90% of ascitic patients.

This is a preview of subscription content, access via your institution.

References

  1. Conn HO, Fessel JM: Spontaneous bacterial peritonitis in cirrhosis: Variations on a theme. Medicine 50:161–197, 1971

    Google Scholar 

  2. Curry N, McCallum RW, Guth PH: Spontaneous peritonitis in cirrhotic ascites. Am J Dig Dis 19:685–692, 1974

    Google Scholar 

  3. Sánchez-Tapias JM, Rodes J, Arrovo V, Bruguera M, Terés J, Bordas JM, Gassull MA, Revert L: Infection peritoneal en la cirrhosis hepatica con ascitis. Revista Clin Espanola, 123:375–380, 1971

    Google Scholar 

  4. Correia JP, Conn HO: Spontaneous bacterial peritonitis in cirrhosis: Endemic or epidemic? Med Clin North Am 59:963–981, 1975

    Google Scholar 

  5. Sánchez-Tapias JM, Terés J, Arroyo V, Bosch J, Bruguera, Rodés J: Spontaneous peritoneal infection in cirrhosis with ascites: Five years of experience. Gastroenterologia y Hepatologia 1:15–21, 1978

    Google Scholar 

  6. Paddock FK: The diagnostic significance of serious fluids in disease. N Engl J Med 223:1010–1015, 1940

    Google Scholar 

  7. Rovelstad RA, Bartholomew LG, Cain JL, McKenzie BF, Soule EH: Ascites I: The value of examination of ascitic fluid and blood for lipids and for proteins by electrophoresis. Gastroenterology 34:436–451, 1958

    Google Scholar 

  8. Kline MM, McCallum RW, Guth DH: The clinical value of ascitic fluid culture and leukocyte count studies in alcoholic cirrhosis. Gastroenterology 70:408–412, 1976

    Google Scholar 

  9. Sampliner RE, Iber FL: High protein with uncomplicated hepatic cirrhosis. Am J Med Sci 267:275–279, 1974

    Google Scholar 

  10. Dorland's Illustrated Medical Dictionary. Twenty-fifth edition, Philadelphia, W.B. Saunders Company, 1974, p. 1632.

  11. Morehead RP: Human Pathology, New York, McGraw-Hill, 1965, p. 1596

    Google Scholar 

  12. Robbins SL: Pathologic Basis of Disease. Philadelphia, W.B. Saunders Company, 1974, p 57

    Google Scholar 

  13. Knieg AF: Cerebrospinal fluid and other body fluids and secretions. Todd-Sanford Clinical Diagnosis by Laboratory Methods. I. Davidson, JB Henry (eds). Philadelphia, W.B. Saunders Company, 1969, p. 1177

    Google Scholar 

  14. McClement JH: Diseases of the pleura. Textbook of Medicine, PB Beeson, W McDermott (eds). Philadelphia, W.B. Saunders Company, 1975, p 874

    Google Scholar 

  15. Bender MD, Ockner RK: Diseases of the peritoneum, mesentery and diaphragm.Gastrointestinal Disease. MH Sleisinger, JF Fordtran (eds). Philadelphia, W.B. Saunders Company, 1973, p 1581

    Google Scholar 

  16. Bar-Meir S, Conn HO: Spontaneous bacterial paritonitis induced by intraarterial vasopressin therapy. Gastroenterology 70:418–421, 1976

    Google Scholar 

  17. Geokas MC, Rinderknecht H, Brodrick JW, Largman C: Studies on the ascites fluid of acute pancreatitis in man. Am J Dig Dis 23:182–188, 1978

    Google Scholar 

  18. Harty RF, Steinberg WM: Ascitic fluid leukocytosis heralding the perforation of a duodenal ulcer (personal communication)

  19. GInsberg MD: Spontaneous group B streptococcal bacteria complicating hepatic cirrhosis: Report of 2 cases. Am J Dig Dis 13:1065–1071, 1968

    Google Scholar 

  20. Ansari A: Spontaneous acute peritonitis with bacteremia in patients with decompensated Laennec's cirrhosis. A clinicopathologic study of two patients. Am J Gastroenterol 55:265–272, 1971

    Google Scholar 

  21. Palutke WA, Boyd CB, Carter GR:Pasteurella multocida septicemia in a patient with cirrhosis: Report of a case. Am J Med Sci 266:305–308, 1973

    Google Scholar 

  22. Targan SR, Chow AW, Guze LB: Spontaneous peritonitis of cirrhosis due toCampylobacter fetus. Gastroenterology 71:311–313, 1976

    Google Scholar 

  23. Targan SR, Chow AW, Guze LB: Role of anaerobic bacteria in spontaneous peritonitis of cirrhosis. Report of two cases and review of the literature. Am J Med 62:397–403, 1977

    Google Scholar 

  24. Bar-Meir S, Chojkier M, Groszmann RJ, Atterbury CE, Conn HO: Spontaneous meningococcal peritonitis. A report of two cases. Am J Dig Dis 23:119–122, 1978

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bar-Meir, S., Lerner, E. & Conn, H.O. Analysis of ascitic fluid in cirrhosis. Digest Dis Sci 24, 136–144 (1979). https://doi.org/10.1007/BF01324741

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01324741

Keywords

  • Public Health
  • Glucose
  • Protein Concentration
  • Glucose Level
  • Differential Diagnosis