1st order laboratory parameters-obligatory laboratory tests-.
- Small blood count
- Differential blood count
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH), gamma-glutamyl transferase (γ-GT, gamma-GT; GGT), alkaline phosphatase, bilirubin.
- Amylase
- Albumin in serum (important protein/protein).
- Total protein in serum
- Renal parameters – creatinine, urea.
- Ascites puncture with bacteriological, cytological examination, determination of protein content, specific gravity and determination of serum/ascites albumin quotient – differentiation of malignant/malignant (from benign/benign) and infected (from non-infected) ascites.
Examination of the ascites punctate including differential diagnosis.
| Laboratory parameters |
Transsudate |
Exudate |
| Protein content |
<30 g/l |
> 30 g/l |
| Specific gravity |
<1.106 g/l |
> 1.106 g/l |
| Serum/ascites albumin quotient (SAAG). |
> 1.1 (= portal-hypertensive ascites). |
< 1.1 (= non-portal-hypertensive ascites) |
| Differential diagnosis |
- Hypalbuminous ascites:
- Malnutrition
- Hypalbuminemia (decreased albumin (protein) concentration in the blood).
- Hypothyroidism (underactive thyroid gland)
- Nephrotic syndrome
- Cardiac (“heart-related”) ascites* :
- Portal ascites* :
- Liver cirrhosis
- Budd-Chiari syndrome (thrombotic occlusion of the hepatic veins),
- Pford vein thrombosis
* Determination of total protein (GE) allows differentiation between cardiac (GE > 2.5 g/dl) and portal hypertensive (GE < 2.5 g/dl) genesis (origin).
|
- Inflammatory ascites: Leukocytes ↑ (pyogenic peritonitis/superficial peritonitis; >250 granulocytes/mm3 define spontaneous bacterial peritonitis, SBP); if infected ascites is suspected, microbiological culturing to detect the causative agent (e.g., tuberculous peritonitis; spontaneous bacterial peritonitis, SBP: mainly gram-negative bacteria, for example, E. coli).
- Malignant (“malignant”) ascites:
- CUP syndrome: Cancer of Unknown Primary (English): cancer with unknown primary tumor (in approximately 20% of cases with malignant ascites/malignant ascites, the primary tumor remains unknown).
- Bronchial carcinoma (lung cancer).
- Endometrial carcinoma
- (cancer of the uterus)
- Gastrointestinal tumors (gastrointestinal tumors).
- Hepatocellular carcinoma (HCC; hepatocellular carcinoma/liver cell cancer).
- Colon carcinoma (colon cancer)
- Liver metastases
- Malignant lymphoma (malignant neoplasm originating from lymphoid cells).
- Gastric carcinoma
- Mammary carcinoma (breast cancer)
- Ovarian carcinoma (ovarian cancer)
- Pancreatic carcinoma (pancreatic cancer)
- Peritoneal carcinomatosis – diffuse metastases (daughter tumors) in the peritoneum (peritoneum).
- Pseudomyxoma peritonei (biliary abdomen)[amylase and lipase ↑]
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For more information, see “Examination of an ascites punctate“.
