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The purpose of this study was to provide evidence-based approaches to detect ascites, perform paracentesis, order tests, and interpret the results. A Medline search was performed to identify relevant articles. Of 731 identified articles, 50 articles were used. The most sensitive findings for ascites detection are ankle edema (93%), increased abdomi...
Contexts in source publication
Context 1
... fluid albumin determination is crucial in determining the etiology of the ascites. The serum-ascites albumin gradient (SAAG) has been shown to be superior to the exudate-transudate concept (using total ascitic fluid protein) for classifying ascitic fluid [9]. The SAAG is the absolute difference between the serum albumin and the ascitic albumin level. The SAAG has been shown to be directly related to an elevation of portal venous pressure [33]. Therefore, it is used to distinguish between sinusoidal portal hypertensive and non-portal hypertensive causes of ascites (Fig. 1). A high SAAG ( ≥ 1 g/dl) identifies ascites due to sinusoidal portal hypertension 97% of the time [9]. Once the cause has been established, it is not necessary to repeat the test for albumin in subsequent paracentesis unless clinically ...
Context 2
... ascitic total protein concentration is a reflection of the serum protein concentration and portal pressure [33]. Tra- ditionally, an ascitic fluid total protein level ≥ 2.5 g/dl was considered an exudate, while total protein < 2.5 g/dl was considered a transudate. This method was only 56% accu- rate in classifying the cause of ascites [9]. While it is not a useful test to distinguish between portal hypertensive and non-portal hypertensive causes of ascites, it is a useful ad- junctive test for elucidating the cause of ascites in the absence of portal hypertension (Fig. 1). A low ascitic total protein ( < 1.0 g/dl) has been associated with a higher risk of spontaneous bacterial peritonitis [35]. However, a consensus has not been reached on the routine use of prophylactic antibiotics to prevent SBP in this setting, as a main concern has been the selection of antibiotic-resistant organisms [1, 10]. High total protein levels ( > 1.0 g/dl) in ascitic fluid are commonly seen in secondary peritonitis (Table ...
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Citations
... The rate of immediate complications from ascites puncture is relatively low, making the procedure safe when performed according to current recommendations, and often compatible with outpatient management [1,2]. Minor complications, such as wall hematomas, occur in 1% of cases, and severe complications, such as hemoperitoneum or bowel perforation, occur in less than one case in 1000 [3]. ...
Introduction
Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also helps the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship.
Objectives
To evaluate the role of simulation-based learning of ascites puncture on the improvement of theoretical knowledge and maintenance of skills at 3 months.
Methods
We conducted an audit type study with two cycles of data collection at the simulation center at the Faculty of Medicine of Sousse between November 2020 and June 2021. We included learners in their third year of medical studies who had a hospital internship in the gastroenterology department at Sahloul Hospital in Sousse. All learners attended the initial simulation session on ascites fluid puncture. Thereafter, they were free to accept or refuse participation in the evaluation session that was scheduled after 3 months, depending on their availability.
Results
Forty learners participated in the procedural simulation of the ascites fluid puncture technique. Thirty-four (85%) were female and six (5%) were male. In our study, we showed that following procedural simulation training of ascites puncture, there was a significant improvement in the theoretical knowledge of the learners (p < 0.000). Objective assessment of technical skills after 3 months showed the benefit of performance maintenance (p < 0.000).
Conclusion
Our study confirmed the benefit of simulation-based learning on the improvement of theoretical knowledge and the maintenance of technical performance in the medium term.
... Apply negative pressure to the syringe during needle insertion until a loss of resistance is felt and a steady flow of ascitic fluid is obtained. After collecting sufficient fluid in the syringe for fluid analysis, either remove the needle and hold pressure to stop bleeding from the insertion site [11]. ...
... The rate of immediate complications from ascites puncture is relatively low, making the procedure safe when performed according to current recommendations, and often compatible with outpatient management (1,2). Minor complications, such as wall hematomas, occur in 1% of cases, and severe complications, such as hemoperitoneum or bowel perforation, occur in less than one case in 1000 (3). ...
Introduction
Medical simulation has become an essential teaching method for all health professionals. It not only allows to acquire technical and non-technical knowledge, but also help the maintenance of acquired knowledge in the medium and long term. Ascites puncture is part of the basic technical procedures learned by medical students during their internship.
Objectives
To evaluate the role of simulation-based learning of ascites puncture on the improvement of theoretical knowledge and maintenance of skills at 3 months.
Methods
We conducted a quasi-experimental study at the simulation center at the Faculty of Medicine of Sousse between November 2020 and June 2021. We included learners in their third year of medical studies who had a hospital internship in the gastroenterology department at Sahloul Hospital in Sousse. All learners attended the initial simulation session on ascites fluid puncture. Thereafter, they were free to accept or refuse participation in the evaluation session that was scheduled after 3 months, depending on their availability.
Results
Forty learners participated in the procedural simulation of the ascites fluid puncture technique. Thirty-four (85%) were female and six (5%) were male. In our study, we showed that following procedural simulation training of ascites puncture, there was a significant improvement in the theoretical knowledge of the learners (p < 0.000). Objective assessment of technical skills after 3 months showed the benefit on performance maintenance (p < 0.000).
Conclusion
Our study confirmed the benefit of simulation-based learning on the improvement of theoretical knowledge and the maintenance of technical performance in the medium term.
... [2] If the ascites is a transudate, 4-5 litres is usually the accepted upper limit of safe drainage to prevent large shifts of intravascular volume. [3] If the ascites is exudative, such as in our case or in TB peritonitis, all the fluid should be removed if possible. This is the second case of spontaneous Staphylococcal peritonitis to be reported. ...
... If the fluid is clear or straw coloured and free flowing, it is most likely a transudate, so no more than 5 L should be removed at a time. [3] If the fluid is cloudy, slow flowing, bloody, milky in appearance, further diagnostic studies are indicated and an attempt to drain all the ascites is appropriate. ...
... Catheter/needle insertion can be performed perpendicular to the skin or using a Z technique, in which the skin is gently pulled down before inserting the needle, creating a diagonal track between the skin and the peritoneal cavity. 156 Anecdotal reports have suggested that the Z-technique could minimize peritoneal fluid leakage after catheter removal 155,158 ; nevertheless, recent adult studies have failed to demonstrate a superiority of the Z-technique in terms of postprocedural fluid leakage. 159 In adults, repeated drainage of 4 to 6 L/day of ascitic fluid has become the standard of care. ...
While initially conceived and designed for adults, percutaneous image-guided drainage of abdominal pelvic and fluid collections has revolutionized the management of several pediatric pathologies. Interventional radiology procedures markedly reduce morbidity and mortality by offering a definitive minimally invasive approach or allowing a cleaner and less challenging subsequent open approach. These procedures are associated with improved patient comfort and rapid recovery. While similar techniques apply to children and adults, successful adaptation of image-guided interventional techniques in children requires consideration of several critical differences. This review aims to discuss the indications, contraindications, and technical aspects of percutaneous image-guided drainage of abdominal and pelvic fluid collections in children.
... Paracentesis is a common diagnostic and therapeutic procedure in the management of ascites, most commonly involving patients with liver disease or malignancy [16]. The procedure is typically very well tolerated, with a low prevalence of complications approaching 1%, particularly when performed with either direct ultrasound guidance (watching the needle under ultrasound for the entire procedure) or ultrasound assistance (use of ultrasound to pick a safe entry site) [17][18][19]. ...
PurposeTo identify commonly used needle types in cross-sectional interventional radiology (CSIR) and to review features and safety profiles of those needles.Methods
Members of the Society of Abdominal Radiology (SAR) emerging technologies commission (ETC) on CSIR were sent a 13-question survey about what needles they use for common CSIR procedures: random and targeted solid organ biopsy, ultrasound-guided paracentesis, and ultrasound-guided thyroid fine needle aspiration (FNA). Results were compiled with descriptive statistics, and features of the most commonly used needles were reviewed.Results19 surveys were completed (response rate 57.6%, 19/33) from 16 institutions. For solid organ biopsies, the majority of respondents reported using an 18-gauge needle with an automatic firing mechanism and a variable throw length option. The most commonly used needle for both random and targeted biopsies was the Argon BioPince (26.3%, 5/19) The three most commonly used needles for solid organ biopsies all featured automatic firing, variable throw length options, and 18-gauge size. A 5 French Cook Yueh needle was most the most commonly used paracentesis needle (36.8%, 7/19). For thyroid FNA, all respondents used spinal needles, and 25-gauge was the most common size (72.2%, 13/18).Conclusion
Abdominal radiologists use a variety of needles when performing common interventional procedures. Members of the SAR CSIR ETC commonly use automatic, 18-gauge, variable throw length needles for solid organ biopsies, 5 French catheter style needles for paracentesis, and 25-gauge spinal needles for thyroid FNA.
... Decompensated hepatic cirrhosis is the leading cause worldwide, and the ascitic fluid is usually transudate in nature with a serum-ascites albumin gradient (SAAG) >1.1 g/dl. [1][2][3][4][5] Ascites is the first sign of malignancy in around half of all patients with peritoneal carcinomatosis secondary to malignancies of the gynecological and gastrointestinal tracts. [6][7][8][9] Detection of malignant cells on effusion cytology in these patients is important for management and disease prognostication. ...
Background: Abdominal paracentesis is a routine diagnostic procedure for assessment of patients with recent onset or worsening of ascites. Objectives: The objective of the study is to (1) review clinically confirmed cases of malignancy with negative, atypical, and suspicious cytology reports and provide reasoning for discrepancies and (2) recalculate sensitivity, specificity, and predictive values after review. Materials and Methods: Papanicolaou smears of ascitic fluid paracentesis samples received over one calendar year were reviewed retrospectively by an expert in cytopathology blinded to the final clinical and/or histopathological diagnoses. Cases with discrepancies after review were noted. Sensitivity, specificity, and predictive values were calculated before and after review of slides. Data were analyzed using SPSS version 16. Results: Malignant etiology was identified in 49/115 cases (42.6%) with female genital tract being the most common site of malignancy (22, 44.8%). The remaining 66 (57.4%) had a benign etiology with hepatic cirrhosis in 42 cases (63.6%). A review revealed discrepancies in five cases, three of which were earlier called negative for malignant cells (one case each of ovarian adenocarcinoma, cecal adenocarcinoma, and cholangiocarcinoma). Two cases of ovarian adenocarcinoma that were reported as atypical/reactive mesothelial hyperplasia showed malignant cells upon review. Sensitivity and specificity after review were 69.4% and 100%, respectively, with 100% positive predictive value. Conclusion: Being a minimally invasive procedure, abdominal paracentesis continues to be an important diagnostic tool in guiding patient management. A proper morphological assessment with adequate clinical information and correlation with other investigations can be used to arrive at a definitive diagnosis in most cases. The term "atypical" can be misleading and is often used for want of clinical information and is best avoided.
... 6 Paracentesis is a safe procedure; however, possible complications include the following: Persistent leakage of asities fluid at the needle insertion site, abdominal wall hematoma, infection, perforation of surrounding vessels or viscera (extremely rare), Hypotension after large-volume fluid removal (more than 5-6 L) and subcutaneous edema due to leakage of ascetic fluid. [7][8][9] A pseudoaneurysm is a collection of blood formed outside a vessel, within the surrounding soft tissues. They are formed due to a connection or channel between blood collection and the damaged blood vessel. ...
Inferior epigastric artery (IEA) pseudoaneurysm is a rare complication following abdominal wall procedures near the artery. This is a case of inferior epigastric artery pseudoaneurysm after therapeutic paracentesis for large‐volume ascites caused by chronic kidney failure. The patient was operated on, and the artery was ligated. A paracentesis procedure could cause complications if the physician ignores some simple rules. IEA pseudoaneurysm is a rare complication of the procedure, so diagnosing this condition is crucial to treat early and avoid rupture.
... A simple and low-cost bedside procedure like abdominal paracentesis may also be helpful in the diagnosis of malignancy-related ascites. Unfortunately, the sensitivity of ascitic fluid cytology for detecting malignancy is much lower at 57-67.1% and paracentesis does not provide core tissue [4][5][6][7][8]. Paracentesis is also not feasible in cases without ascites, which accounts for two-thirds of patients with peritoneal carcinomatosis [9]. ...
Background
Diagnostic laparoscopy is often a necessary, albeit invasive, procedure to help resolve undiagnosed peritoneal diseases. Previous retrospective studies reported that EUS-FNA is feasible on peritoneal and omental lesions, however, EUS-FNA provided a limited amount of tissue for immunohistochemistry stain (IHC).
Aim
This pilot study aims to prospectively determine the effectiveness of EUS-FNB regarding adequacy of tissue for IHC staining, diagnostic rate and the avoidance rate of diagnostic laparoscopy or percutaneous biopsy in patients with these lesions.
Methods
From March 2017 to June 2018, patients with peritoneal or omental lesions identified by CT or MRI at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were prospectively enrolled in the study. All Patients underwent EUS-FNB. For those with negative pathological results of EUS-FNB, percutaneous biopsy or diagnostic laparoscopy was planned. Analysis uses percentages only due to small sample sizes.
Results
A total of 30 EUS-FNB passes were completed, with a median of 3 passes (range 2–3 passes) per case. For EUS-FNB, the sensitivity, specificity, PPV, NPV and accuracy of EUS-FNB from peritoneal lesions were 63.6%, 100%, 100%, 20% and 66.7% respectively. Adequate tissue for IHC stain was found in 25/30 passes (80%). The tissues from EUS results were found malignant in 7/12 patients (58.3%). IHC could be done in 10/12 patients (83.3%). Among the five patients with negative EUS results, two underwent either liver biopsy of mass or abdominal paracentesis, showing gallbladder cancer and adenocarcinoma. Two patients refused laparoscopy due to advanced pancreatic cancer and worsening ovarian cancer. The fifth patient had post-surgical inflammation only with spontaneous resolution. The avoidance rate of laparoscopic diagnosis was 58.3%. No major adverse event was observed.
Conclusions
EUS-FNB from peritoneal lesions provided sufficient core tissue for diagnosis and IHC. Diagnostic laparoscopy can often be avoided in patients with peritoneal lesions.
... 9 Care should be taken to avoid far lateral sites, engorged veins or previous scars. 7 The landmarks can be shifted slightly laterally to account for scarring from regular paracentesis. We believe this approach to be safer and more anatomically correct in the absence of ultrasound guidance, and encourage a revision to Figure 4. ...
