Studies on ascitic fluid in patients with hepatic cirrhosis, heart failure and cancer: results of cephalin cholesterol flocculation, thymol turbidity, methylene blue, qualitative and quantitative bilirubin and other tests

Summary

The cephalin cholesterol flocculation test, the thymol turbidity test, methylene blue, bilirubin, direct diazo reaction, Hay test, urobilinogen test, specific gravity and Rivalta test, have been carried out on the ascites and blood of 40 patients with cirrhosis of the liver, congestive heart failure and peritoneal carcinomatosis. The cephalin cholesterol flocculation test was “positive” in 100 percent of specimens of ascitic fluid of hepatic cirrhosis. In the blood of the same patients this test was “positive” in 96 percent. In ascites caused by heart failure “positive” tests were present in 89 percent, and in ascites caused by cancer in 78 percent. In each of these two groups the blood test was “positive” in 56 percent.

In contrast, the ascitic fluid thymol turbidity test in patients with hepatic cirrhosis was negative in all instances while in the blood of the same patient, this test was positive in 83 percent. In congestive heart failure and peritoneal carcinomatosis the ascitic fluid thymol turbidity test was negative in all but one instance, whereas the blood thymol turbidity test was positive in approximately one-quarter of the same cases. The significance of the contrasting results of both tests has been discussed.

Only 2 of 4 specimens of ascitic fluid gave positive methylene blue tests, although in many specimens the van den Bergh test showed a considerable amount of bilirubin present. The direct diazo reaction in these two specimens was “prompt,” whereas in other specimens giving a negative methylene blue test “delayed” or “biphasic” reactions were observed. The changes of the quantity and the quality (direct diazo reaction) of the bilirubin during the passage from the blood to the ascites have been reported and discussed. The Hay test for cholic acids was negative in the 44 examined specimens of ascitic fluid of all groups. Similarly, in the same specimens the urobilinogen test was negative with one exception.

Studies of the specific gravity and Rivalta test of ascitic fluid of all groups revealed that these tests have but limited value in the differentiation of exudates and transudates.