1. Peritoneal Fluid
Examination
Presented By:
Nasir Nazeer

2. Peritoneal Fluid
Peritoneal fluid is a liquid that is made in the abdominal
cavity to lubricate the surface of the tissue that lines
the abdominal wall, pelvic cavity and covers most of the
organs in the abdomen.
The peritoneal cavity is the space between the abdominal
organs (such as the stomach, spleen, liver and gall
bladder) and the membranes which line the wall of the
abdomen.
The peritoneal fluid is a clear, sterile fluid which is mostly
water along with some white blood cells, antibodies,
electrolytes and other bio-chemicals
The main function of the peritoneal fluid is to ease friction
caused by the movement of the abdominal organs, as
they move around in the abdominal cavity.

3. Reasons for the tests
Peritoneal fluid analysis is used to help diagnose the cause of
peritoneal fluid accumulation (ascites) and/or inflammation of
the peritoneum (peritonitis).
There are two main reasons for fluid accumulation, and an
initial set of tests (fluid albumin level, cell count and
differential, and appearance) is used to differentiate between
the two types of fluid that may be produced.
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An imbalance between the pressure within blood vessels (which
drives fluid out of the blood vessel) and the amount of protein in
blood (which keeps fluid in the blood vessel) can result in
accumulation of fluid (called a transudate). Transudates are
most often caused by congestive heart failure or cirrhosis. If the
fluid is determined to be a transudate, then usually no more tests
on the fluid are necessary.

4. Reasons for the tests (Cotd..)
Injury or inflammation of the peritoneum may cause
abnormal collection of fluid (called an exudate) Exudates
are associated with a variety of conditions and diseases,
and several tests, in addition to the initial ones are
performed and may be used to help diagnose the specific
condition, including:
Infectious diseases caused by viruses, bacteria, or fungi. Infections
may originate in the peritoneum, due to a rupture of the appendix,
perforation of the intestines or the abdominal wall, contamination
during surgery, or may spread to the peritoneum from other places in
the body.
Inflammatory conditions – peritonitis due to certain chemicals,
irradiation, rarely due to an autoimmune disorder
Malignancies – such as mesothelioma, tumor of the liver
(hepatoma), lymphoma, or metastatic cancer.
Pancreatitis

5. Additional testing on exudate fluid
may include:
Peritoneal fluid glucose, amylase, tumor markers
Microscopic examination – may be performed if infection
or cancer is suspected. Laboratories may examine drops
of the peritoneal fluid and/or use a special centrifuge
(cyto-centrifuge) to concentrate the fluid's cells at the
bottom of a test tube. Samples are placed on a slide,
treated with a special stain, and an evaluation of the
different kinds of cells present is performed.
Gram stain – for direct observation of bacteria or fungi
under a microscope
Bacterial culture and susceptibility testing—ordered to
detect any microorganisms, which will grow in the culture,
and to guide antimicrobial therapy

6. When peritoneal fluid analysis is
ordered?
Peritoneal fluid analysis is ordered when a
doctor suspects that a person has a
condition or disease that is causing
peritonitis and/or ascites. It may be
ordered when someone has:
Ascites of unknown origin
Abdominal pain and tenderness
Intestinal perforation
Suspected intra-abdominal malignancy

7. How to Prepare Patient for the
Test?
Before drawing sample preliminary
information should be collected from the
patient.
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Is patient taking any medications (including
herbal remedies)?
Patient having any allergies to medications or
numbing medicine?
Patient having any bleeding problems?
Is patient pregnant or not?

8. Patient preparation before drawing
sample
Following procedure
peritoneal fluid.





is
adopted
to
draw
Patient is directed to empty his bladder before
undergoing the abdominal tap.
A small section of the abdomen is cleaned with
antiseptic.
Local anesthesia is given to the patient.
A needle is inserted to draw out the fluid. Patient may
feel a pressure when the needle is being inserted.
Patient might feel a little light-headed or dizzy if a
large amount of fluid is extracted.

9. Peritoneal
Fluid

10. Risks Involved
There is a slight risk that the needle may
puncture the bladder, bowel or a blood vessel.
This can result in perforation and bleeding, or
infection of the bowel. Ovarian and cervical
cancers are the leading causes of cancer in
women, leading to death. The progress of this
disease is very insidious, because very often
there are hardly any symptoms, and the cancer
may be in a very advanced stage before it is
discovered. Cytological examination of peritoneal
fluid is very helpful in detecting the presence of
cancer cells or other genetic abnormalities in
ovarian and cervical cancer, at an early stage.

11. What does the test result mean?
Test results can help to distinguish
between types of peritoneal fluid and help
to diagnose the cause of fluid
accumulation. The initial set of tests
performed on a sample of peritoneal fluid
helps determine whether the fluid is
a transudate or exudate.

12. What does the test result mean?
Transudate fluid:
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Ninety percent of ascitic fluids are Transudates and
are
caused
by
either congestive
heart
failure or cirrhosis. Typical fluid analysis results
include:
Physical characteristics—fluid appears clear
Albumin level—low (typically evaluated as the
difference between serum albumin and peritoneal
fluid albumin, termed serum-ascites albumin gradient,
or SAAG. Values above 1.1 g/dL are considered
evidence of a transudate.)
Cell count—few cells are present

13. What does the test result mean?
Exudate
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Physical characteristics—fluid may appear
cloudy
Albumin level—higher than in transudates
(typically with a SAAG less than 1.1 g/dL)
Cell count—increased

14. Exudate fluid and tests
Exudates can be caused by a variety of conditions and
diseases and usually require further testing to aid in the
diagnosis. Exudates may be caused by, for example,
infections, trauma, various cancers, or pancreatitis. The
following is a list of additional tests that the doctor may
order depending on the suspected cause and typical
results.
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Physical characteristics – the normal appearance of a sample of
peritoneal fluid is usually straw-colored and clear. Abnormal
appearances may give clues to conditions or diseases present and
may include:
Yellow with liver disease, milky from obstruction of the lymphatic
system, and greenish from bile
Reddish peritoneal fluid may indicate the presence of blood.
Cloudy
peritoneal
fluid
may
indicate
the
presence
of microorganisms and/or white blood cells pointing to an infection.

15. Exudate fluid and tests (Contd..)
Chemical tests – that may be performed in
addition to albumin may include:


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Glucose—typically about the same as blood
glucose levels; may be lower with infection.
Amylase—increased with pancreatitis
Tumor
markers—to
identify
type
of
malignancy

16. Exudate fluid and tests (Contd..)
Microscopic examination – may be performed if
infection or cancer is suspected. Normal peritoneal fluid
has small numbers of white blood cells (WBCs) but no
red blood cells (RBCs) or microorganisms. Results of an
evaluation of the different kinds of cells present may
include:



Total cell counts—WBCs and RBCs in the sample are
enumerated. Increased WBCs may be seen with infections and
malignant conditions.
WBC differential—determination of percentages of different types
of WBCs. An increased number of neutrophils may be seen with
bacterial infections.
Cytology – a cytocentrifuged sample is treated with a special
stain and examined under a microscope for abnormal cells and
for white cell differentiation. The differential can help determine
whether the cells are the result of an infection or the presence of
a tumor.

17. Exudate fluid and tests (Contd..)
Infectious disease tests – tests may be performed to look for
microorganisms if infection is suspected.
Gram stain – for direct observation of bacteria or fungi under a
microscope. There should be no organisms present in peritoneal
fluid.
Bacterial culture and susceptibility testing—If bacteria are present,
susceptibility testing can be performed to guide antimicrobial
therapy. If there are no microorganisms present, it does not rule out
an infection; they may be present in small numbers or their growth
may be inhibited because of prior antibiotic therapy.
Less commonly, if testing for other infectious diseases is performed
and is positive, then the cause of the peritoneal fluid accumulation
may be due to a viral infection, mycobacteria (such as the
mycobacterium that causes tuberculosis, or aparasite.