Paracentesis

Excerpt

Ascites, characterized by abnormal fluid accumulation in the peritoneal cavity, often emerges as a grim harbinger of underlying liver cirrhosis, a condition with a daunting prognosis. Paracentesis, a pivotal medical procedure, is the key to understanding and managing this complex condition. Diagnostic paracentesis provides a window into the origins of ascites, enabling healthcare professionals to pinpoint its underlying cause and rule out peritoneal fluid infection. In contrast, therapeutic paracentesis is a powerful tool for alleviating the distressing symptoms associated with ascites by safely removing substantial volumes of ascitic fluid.

This review addresses the indications, contraindications, and potential complications of paracentesis, providing invaluable insights for healthcare practitioners. Additionally, it underscores the crucial role of an interprofessional team in managing patients with ascites, as early diagnosis and intervention can significantly impact patient outcomes. In a world where liver cirrhosis remains a leading cause of ascites, understanding the nuances of paracentesis becomes an essential skill for healthcare professionals.

Paracentesis is a procedure performed in patients with ascites, during which a needle is inserted into the peritoneal cavity to obtain ascitic fluid. The removal and testing of the ascitic fluid to diagnose the etiology of ascites or to rule out an infection of peritoneal fluid is called diagnostic paracentesis. Therapeutic paracentesis refers to removing large quantities of ascitic fluid to treat the patient's symptoms caused by ascites.

The most common cause of ascites is cirrhosis of the liver. Patients who develop ascites due to liver cirrhosis have an estimated one-year mortality rate of 20% compared to a one-year mortality rate of 7% in patients with cirrhosis and without the development of ascites. Therefore, the ascitic fluid should be sampled in all patients with new-onset ascites.

Ascites can be of 2 types: exudative and transudative. Regarding the differentiation between transudate and exudate, the preferred way to distinguish ascites is the serum-ascitic albumin gradient (SAAG). The SAAG is directly related to portal pressure. The SAAG level greater than or equal to 1.1 g/dL indicates portal hypertension and transudative ascites. If this level is less than 1.1 g/dL, it means exudative ascites. The causes of transudative ascites include the following:

1. Hepatic cirrhosis

2. Heart failure

3. Alcoholic hepatitis

4. Fulminant hepatic failure

5. Nephrotic syndrome

6. Portal vein thrombosis

The causes of exudative ascites include the following:

1. Peritoneal carcinomatosis

2. Pancreatitis

3. Peritonitis

4. Ischemic colitis

5. Intestinal obstruction