Liver Diseases pp 443-446 | Cite as

Peritoneal Fluid Analysis

  • Giulia Tosetti
  • Vincenzo La MuraEmail author


The abnormal accumulation of peritoneal fluid in the abdomen is a frequent complication in patients with cirrhotic and non-cirrhotic portal hypertension which is defined as ascites whose appearance heralds worsening of prognosis in such chronic diseases of the liver. Ascites can be also associated with acute liver failure, hepatic and extra-hepatic malignancies, infections (among them tuberculosis), pancreatitis, malnutrition or malabsorption or other rare inflammatory conditions. Therefore, peritoneal fluid analysis is mandatory to differentiate these clinical conditions in order to guide the best clinical management and treatment. This chapter summarizes the most important principles of peritoneal fluid analysis to best differentiate the etiological diagnosis of ascites.


Ascites Paracentesis Cirrhosis Non cirrhotic ascites Serum-ascites albumin gradient (SAAG) 


  1. 1.
    Runyon BA, AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: update 2012. Hepatology. 2013;57(4):1651–3.CrossRefGoogle Scholar
  2. 2.
    European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–60.CrossRefGoogle Scholar
  3. 3.
    Wong F. Management of ascites in cirrhosis. J Gastroenterol Hepatol. 2012;27(1):11–20.CrossRefGoogle Scholar
  4. 4.
    De Gottardi A, Thévenot T, Spahr L, et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Hepatol. 2009;7(8):906–9.CrossRefGoogle Scholar
  5. 5.
    Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference. Under the auspices of the Italian Association for the Study of Liver Diseases (AISF) and the Italian Society of Internal Medicine (SIMI). Dig Liver Dis. 2016;48:455–67.Google Scholar
  6. 6.
    Uddin MS, Hoque MI, Islam MB, et al. Serum-ascites albumin gradient in differential diagnosis of ascites. Mymensingh Med J. 2013;22(4):748–54.PubMedGoogle Scholar
  7. 7.
    Kim JJ, Tsukamoto MM, Mathur AK. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol. 2014;109(9):1436–42.CrossRefGoogle Scholar
  8. 8.
    Cavazzoni E, Bugiantella W, Graziosi L, et al. Malignant ascites: pathophysiology and treatment. Int J Clin Oncol. 2013;18:1–9.CrossRefGoogle Scholar
  9. 9.
    Farias AQ, Silvestre OM, Garcia-Tsao G, et al. Serum B-type natriuretic peptide in the initial workup of patients with new onset ascites: a diagnostic accuracy study. Hepatology. 2014;59(3):1043–51.CrossRefGoogle Scholar
  10. 10.
    Guillaume M, Robic MA, Péron JM, et al. Clinical characteristics and outcome of cirrhotic patients with high protein concentrations in ascites: a prospective study. Eur J Gastroenterol Hepatol. 2016;28(11):1268–74.CrossRefGoogle Scholar
  11. 11.
    Riker D, Goba D. Ovarian mass, pleural effusion, and ascites: revisiting Meigs syndrome. J Bronchol Interv Pulmonol. 2013;20(1):48–51.CrossRefGoogle Scholar
  12. 12.
    Field Z, Zori A, Khullar V. Malignant peritoneal mesothelioma presenting as mucinous ascites. ACG Case Rep J. 2018;5:e23.CrossRefGoogle Scholar
  13. 13.
    Chauhan A, Patodi N, Ahmed M. A rare cause of ascites: pseudomyxoma peritonei and a review of the literature. Clin Case Rep. 2015;3(3):156–9.CrossRefGoogle Scholar
  14. 14.
    Khalid S, Asad-Ur-Rahman F, Abbass A, et al. Myxedema ascites: a rare presentation of uncontrolled hypothyroidism. Cureus. 2016;8(12):e912.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Karlapudi S, Hinohara T, Clements J, et al. Therapeutic challenges of pancreatic ascites and the role of endoscopic pancreatic stenting. BMJ Case Rep. 2014; Scholar
  16. 16.
    Lizaola B, Bonder A, Trivedi HD, et al. Review article: The diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther. 2017;46(9):816–24.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.CRC “A.M. and A. Migliavacca” Center for liver disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoUniversità degli studi di MilanoMilanItaly
  2. 2.Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, U.O.C. Medicina Generale Emostasi e Trombosi, Dipartimento di Scienze Biomediche per la SaluteUniversità degli studi di MilanoMilanItaly

Personalised recommendations