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Abdominal Paracentesis
Ascites is an abnormal increase in fluid within the peritoneal (abdominal) cavity. The normal abdominal cavity has a small amount of fluid (usually less than 150 mL). Cirrhosis (chronic liver disease) with associated portal hypertension (blood pressure within the liver above the normal range of 5 to 8 mm Hg) is the most common cause of ascites. Other causes of ascites include cancer, heart failure, kidney failure, tuberculosis, and pancreatic disease. An abdominal paracentesis involves the surgical puncture of the abdominal cavity with a needle and placement of a catheter line for the removal of excess fluid. The procedure can be diagnostic in helping identify the cause of ascites or may be used as a therapeutic measure if a large volume of fluid can be removed to lessen discomfort and improve breathing. The March 12, 2008, issue of JAMA includes an article about paracentesis techniques. It identifies ways to decrease the risk of complications and to improve diagnostic accuracy.
PATIENTS WHO SHOULD UNDERGO DIAGNOSTIC PARACENTESIS
- Patients with new-onset ascites
- Patients with chronic ascites and at least one of the following symptoms:
- Fever
- Abdominal pain
- Increasing ascites volume—increasing abdominal girth
- Unexplained encephalopathy (confusion or disorientation)
- Declining liver function
- Kidney failure
RISKS AND COMPLICATIONS OF ABDOMINAL PARACENTESIS
With current techniques, diagnostic paracentesis is considered a safe procedure. Some coagulopathies (bleeding disorders) may make the procedure too risky to perform. Pregnancy, organomegaly (abnormally enlarged organs), severe bowel or bladder distention, and previous abdominal-pelvic surgery may increase the risk of the procedure. In those situations, an ultrasound-guided paracentesis should be considered. Procedural complications are rare but can include
- Persistent leakage of ascitic fluid
- Circulatory problems, such as lowered blood pressure
- Localized infection at the puncture site
- Abdominal wall blood clots or bruises
- Bleeding
- Injury to organs in the abdomen
ANALYSIS OF ASCITIC FLUID
Tests of the removed fluid help to establish the cause of the ascites and to rule out infection. These tests include counts of the numbers and types of cells in the fluid. Testing for albumin (a simple protein) should be done in cases of new ascites. Additional tests may be done depending on the patient's history and physical examination.
FOR MORE INFORMATION
INFORM YOURSELF
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish.
Sources: American Association for the Study of Liver Disease, American Gastroenterological Association, American Academy of Family Physicians
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724.
TOPIC: PROCEDURES
John L. Zeller, MD, PhD, Writer;
Alison E. Burke, MA, Illustrator;
Richard M. Glass, MD, Editor
JAMA. 2008;299(10):1216.
RELATED ARTICLE
Does This Patient Have Bacterial Peritonitis or Portal Hypertension? How Do I Perform a Paracentesis and Analyze the Results?
Camilla L. Wong, Jayna Holroyd-Leduc, Kevin E. Thorpe, and Sharon E. Straus
JAMA. 2008;299(10):1166-1178.
ABSTRACT
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