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The following are standard tests in suspected ascites:

  • ultrasound
  • diagnostic paracentesis in which 30 to 50 ml of fluid is withdrawn. This will enable identification of:
    • protein content: albumin and total protein
    • malignant cells
    • bacteria
    • white blood cells
    • glucose

If there is a very high white cell count, i.e. greater than 250/mm cubed, which is predominantly polymorphs, then this is suggestive spontaneous bacterial peritonitis. Often such an infection is due to coliforms.

A sample of fluid that contains more than one type of organism suggests possible bowel perforation or a contaminated sample. Other tests on the ascitic fluid may be considered:

  • amylase - helps detect pancreatic ascites and gut perforation in the peritoneal cavity
  • tuberculous smear and culture

Last reviewed 01/2018

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