Peritoneal Fluid Test Procedure

Peritoneal fluid is a fluid that accumulates in the peritoneal cavity, which is the space between the inner layer of the abdominal wall and the organs within the abdominal cavity. This fluid provides a lubricating and nourishing environment for the organs and also helps remove waste products. It can also be used for dialysis in certain medical conditions. Peritoneal Fluid Test Procedure is here.

Testing Steps:

A peritoneal fluid test procedure involves the following steps:

1. Sample preparation: The fluid sample is prepared for analysis by centrifuging it to separate the cells and other solid particles from the clear liquid.
2. Appearance: The appearance of the fluid is noted, including its color, clarity, and presence of any unusual particles.
3. Volume: The volume of fluid is measured to determine if it is within normal limits.
4. Specific gravity: The specific gravity of the fluid is measured to determine if it is a transudate or exudate fluid.
5. pH: The pH of the fluid is measured to determine its acidity or alkalinity.
6. Glucose level: The glucose level of the fluid is measured to assess if it is similar to the level in the bloodstream.
7. Protein level: The protein level of the fluid is measured to evaluate if there is inflammation or infection.
8. Cell count: A cell count is performed to determine the number of white blood cells, red blood cells, and other cells present in the fluid.
9. Microscopic examination: The fluid is examined under a microscope to check for the presence of abnormal cells or other substances.
10. Culture: A culture of the fluid may be performed to determine if any microorganisms are present and to identify the cause of an infection.
11. Interpretation of results: The results of the analysis are interpreted by a healthcare provider to assist in the diagnosis of medical conditions and to monitor the progress of treatment.

It’s important to note that a peritoneal fluid test may have some risks and side effects, including pain, bleeding, and infection, so it’s important to discuss these with a healthcare provider before the procedure.

Analysis Steps:

• Physical Examination
• BioChemical Examination
• Cytological Examination

Physical Examination:

A physical examination of peritoneal fluid involves the following steps:

1. Appearance: The appearance of the fluid is observed, including its color, clarity, and presence of any unusual particles.
   [fluid generally appears clear or straw-colored]
2. Volume: The volume of fluid is measured to determine if it is within normal limits.
   [Normal: <50 ml]
3. Specific gravity: The specific gravity of the fluid is measured, which can indicate if it is a transudate or exudate fluid.
   [Normal: 1.010 to 1.025]
4. pH: The pH of the fluid is measured to determine its acidity or alkalinity.
   [Normal: 6.5 to 7.5]

BioChemical Examination:

A biochemical examination of peritoneal fluid involves measuring the levels of various substances in the fluid to help diagnose and monitor medical conditions. Some of the common tests performed as part of a biochemical examination of peritoneal fluid include:

1. Glucose level: The glucose level of the fluid is measured to assess if it is similar to the level in the bloodstream.
   [Normal: 70 to 100 mg/dL]
2. Protein level: The protein level of the fluid is measured to evaluate if there is inflammation or infection.
   [Normal: <4.1 g/dL _{Maybe Difference with difference laboratories}]
3. Amylase level: The level of the enzyme amylase is measured to diagnose or monitor pancreatitis.
   [Normal: 138 to 404 units/L]
4. Lactate dehydrogenase (LDH) level: The level of the enzyme LDH is measured to evaluate the extent of tissue damage.
   [Normal: same serum  level]

These tests provide important information about the presence of disease or injury and can assist in the diagnosis and management of medical conditions.

Cytological Examination:

Cytological examination of peritoneal fluid involves the examination of cells present in the fluid to help diagnose and monitor medical conditions. Some of the common tests performed as part of a cytological examination of peritoneal fluid include:

1. Cell count: A cell count is performed to determine the number of white blood cells, red blood cells, and other cells present in the fluid.
   [Normal: RBCs= Nil / WBCs= <300/cmm ]
2. Cell morphology: The shape and structure of the cells are evaluated to assess for any abnormalities.
   [Normal: Nutrophils =Nil / Lymphocytes= 100%]
3. Gram staining: Gram stain is a laboratory technique used to differentiate between different types of bacteria based on their cell wall structure.
   [Normal: No Bacteria Found ]
4. Cytology – This test involves examining a sample of the fluid under a microscope to look for abnormal cells, which can indicate the presence of cancer.
   [Normal: no malignant cells / No fungal bodies]

These tests provide important information about the presence of disease or injury and can assist in the diagnosis and management of medical conditions. A positive result on a cytological examination can indicate the presence of a cancerous or pre-cancerous condition and may lead to further diagnostic testing.

Serum Ascites Albumin Gradient (SAAG)

The serum-ascites albumin gradient (SAAG) is a medical test used to determine the cause of ascites, the buildup of fluid in the abdomen. The test measures the difference in the levels of albumin in the blood (serum) and in the fluid collected from the peritoneal cavity (ascites).

Differentiation of exudate and transudate:

Parameter	Transudate	Exudate
Appearance	Pale yellow No turbidity	Yellow = inflammatory Red = hemorrhage Brown = bilirubin Turbid, viscous,  cloudy
Protein	<3 g/dL	>3 g/dL
Fluid protein: serum protein ratio	<0.5	>0.5
Fluid LD: LD ratio	<0.6	>0.6
Specific gravity	<1.016 (<1.015)	>1.016 (>1.015)
WBC	Absent	Increased
LDH	Normal  <200 IU/L	Increased >200 IU/L
Glucose	Normal (equal to serum level)	<than or equal to serum
Pleural fluid cholesterol	<60 mg/dL	>60 mg/dL
Pleural fluid: serum cholesterol  ratio	<0.3	>0.3
Pleural fluid: bilirubin ratio	<0.6	>0.6
Fibrinogen	No clot	Clots are seen
Spontaneous clotting	Negative	May see clot formation
Cell count	300 to 1000 /cmm	>1000 /cmm
Differential	Mononuclear cells predominate <25% neutrophils	>25% neutrophils

Pritoneal Fluid In Various Diseases

Disease	appearance	Protein g/dL	Sp.gravity	RBC/cmm	WBC/cmm	Type of cell
Cirrhosis	straw color/bile stained	< 2.5	<1.016		<250	pred. meso. cells
TB peritonitis	clear/turbid or chylous	> 2.5	>1.016	variable	>1000	variable/Lymph
Neoplasm	straw/haem./mucin	>2.5	>1.016	variable	10000	malignant cell-positive
Pyogenic peritonitis	Turbid	>2.5	> 1,016	uncommon	>10,000	polys
Congestive H.failure	Straw	variable	variable	variable	>1000	mesoth. cells
Nephrosis	straw/chylous	<2.5	<1.016	variable	< 250	mesoth./mononucl.
Pancreatitis	turbid/haem	>2.5	>1.016	variable	variable	polys

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Possible References Used

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