Abdominal paracentesis

Gross appearance of fluid

Transparent yellow
or
Crystal clear
or
Cloudy yellow

Gross appearance of fluid

Bloody

Gross appearance of fluid

Milky

Gross appearance of fluid

Dark brown

Special testing
or
Cell count correction

TG concentration

Special testing
or
Cell count correction

Subtract 1 WBC/750 RBCs
Subtract 1 PMN/250 RBCs

Special testing
or
Cell count correction

Bilirubin concentration

Polymorphonuclear neutrophil (PMN) count (cells/mm³)

250

Other testing

Total protein <2.5 g/dL

Working diagnosis

Cardiac ascites

Working diagnosis

Uncomplicated cirrhotic ascites

Confirmatory testing

US and/or liver biopsy

End

Confirmatory testing

Chest film and echocardiogram

Working diagnosis

Nephrotic ascites

Confirmatory testing

24-hour urine protein excretion

Working diagnosis

Secondary bacterial peritonitis

Working diagnosis

SBP

Confirmatory testing

Clinical response to antibiotic

Confirmatory testing

Upright abdominal film, abdominal CT with water-soluble contrast

Working diagnosis

Pancreatic ascites

Abdominal CT

Other testing

Positive cytology

Other testing

Send fluid for TB testing

Working diagnosis

Peritoneal carcinomatosis and portal hypertension

Working diagnosis

Tuberculous peritonitis and underlying cirrhosis

Confirmatory testing

Search for primary tumor

Confirmatory testing

Mycobacterial growth on culture of laparoscopic biopsy specimen of peritoneum

Other testing

Positive cytology

Other testing

Send fluid for TB testing

Working diagnosis

Tuberculous peritonitis

Working diagnosis

Peritoneal carcinomatosis

LDH, Lactic dehydrogenase; PMN, polymorphonuclear neutrophil; RBC, red blood cell; TP, total protein.

White blood cell (WBC) count (cells/mm³)

<500

White blood cell (WBC) count (cells/mm³)

500

Polymorphonuclear neutrophil (PMN) count (cells/mm³)

<250

Polymorphonuclear neutrophil (PMN) count (cells/mm³)

250

Other testing

Total protein <2.5 g/dL

Other testing

Total protein 2.5 g/dL

Serum-ascites albumin gradient (SAAG) (g/dL)

1.1

Serum-ascites albumin gradient (SAAG) (g/dL)

<1.1

Other testing

Single organism in culture, TP <1 g/dL, Glucose >50 mg/dL, LDH <225 U/L

Other testing

Polymicrobial infection, TP >1 g/dL, Glucose <50 mg/dL, LDH 225 U/L

Serum-ascites albumin gradient (SAAG) (g/dL)

1.1

Serum-ascites albumin gradient (SAAG) (g/dL)

<1.1

Other testing

Polymicrobial infection, TP >1 g/dL, Glucose <50 mg/dL, LDH 225 U/L

Other testing

Ascitic fluid amylase >100 U/L

50% PMNs

<50% PMNs

Serum-ascites albumin gradient (SAAG) (g/dL)

1.1

Serum-ascites albumin gradient (SAAG) (g/dL)

<1.1