Effect of Marked Peripheral Leukocytosis on the Leukocyte Count in Ascites

Antilion, Mainor R.; Runyon, Bruce A.

doi:10.1001/archinte.1991.00400030069012

Cited by 14 publications

(2 citation statements)

References 6 publications

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“…The current diagnostic standard is an ascitic fluid PMN count ≥250 cells/mm 3 which has a sensitivity of 80%-100% and a specificity of 86%-100% [10]. Ascitic leukocyte (or neutrophil) count is not influenced by peripheral leukocytosis (or neutrophilia) [25]. Several studies have examined the use of urine dipsticks to detect neutrophils in ascitic fluid at the bedside [26][27][28][29][30].…”

Section: What Tests Should Be Ordered and What Do The Results Mean?mentioning

confidence: 99%

An Evidence-Based Manual for Abdominal Paracentesis

et al. 2007

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The purpose of this study was to provide evidence-based approaches to detect ascites, perform paracentesis, order tests, and interpret the results. A Medline search was performed to identify relevant articles. Of 731 identified articles, 50 articles were used. The most sensitive findings for ascites detection are ankle edema (93%), increased abdominal girth (87%), flank dullness (84%), and bulging flanks (81%). Paracentesis is safe, with bleeding rates and leakage of <1%. An ascitic fluid polymorphonuclear cell count >or=250 cells/mm(3) is the most sensitive test (86%-100%) to diagnose spontaneous bacterial peritonitis. The serum-ascites albumin gradient is the most useful test in identifying portal hypertension-related ascites. Large-volume paracentesis is effective in the treatment of refractory ascites. We conclude that paracentesis is a safe and vital procedure in patients with new-onset ascites. Once detected, an algorithmic approach to ordering tests and their interpretation is useful to determine etiology and direct further management.

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Section: What Tests Should Be Ordered and What Do The Results Mean?mentioning

confidence: 99%

An Evidence-Based Manual for Abdominal Paracentesis

et al. 2007

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“…In addition, they can develop SBP. These patients do not develop false-positive elevated ascitic fluid PMN counts because of peripheral leukocytosis 63 ; it must be presumed that an elevated PMN count represents SBP. Empiric antibiotic treatment, for presumed ascitic fluid infection, of patients with alcoholic hepatitis who have fever and/or peripheral leukocytosis can be discontinued after 48 hours if ascitic fluid, blood cultures, and urine cultures show no bacterial growth.…”

Section: Introductionmentioning

confidence: 87%

Management of adult patients with ascites caused by cirrhosis†

Runyon¹

1998

Hepatology

302

131

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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Does This Patient Have Bacterial Peritonitis or Portal Hypertension? How Do I Perform a Paracentesis and Analyze the Results?

Wong

Holroyd‐Leduc²,

Thorpe³

et al. 2008

JAMA

105

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A 44-year-old man with cirrhosis is admitted with fever but has no obvious source of infection. His physical examination reveals ascites and minimal abdominal tenderness. Why Is This Procedure Important?In a previous Rational Clinical Examination article, Williams and Simel 1 discussed the previous scenario and suggested performing a diagnostic paracentesis to seek for the source of the patient's fever. Ascites is the most common major complication of cirrhosis. 2 The syndrome of infected ascites was first recognized and described in the European literature in the early 20th century. [2][3][4] Infection occurs in as many as 27% of cirrhosis patients admitted to the hospital for evaluation and management of symptoms associated with ascites. The presentation of spontaneous bacterial peritonitis can range from silent to overt 5 ; however, patients typically have nonspecific symptoms such as nausea, abdominal pain, malaise, fever, or mild confusion. In reports 6 from the 1970s, the mortality rate from spontaneous bacterial peritonitis exceeded 90% but recent data 7 show a lower mortality rate of 30%. Diagnosis and subsequent treat-See also Patient Page. CME available online at www.jamaarchivescme.com and questions on p 1203.Context Abdominal paracenteses are performed in patients with ascites, most commonly to assess for infection or portal hypertension and to manage refractory ascites.Objectives To systematically review evidence for paracentesis methods that may decrease risk of adverse events or improve diagnostic yield and to determine the accuracy of ascitic fluid analysis for spontaneous bacterial peritonitis or portal hypertension.

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Effect of Marked Peripheral Leukocytosis on the Leukocyte Count in Ascites

Cited by 14 publications

References 6 publications

An Evidence-Based Manual for Abdominal Paracentesis

An Evidence-Based Manual for Abdominal Paracentesis

Management of adult patients with ascites caused by cirrhosis†

Does This Patient Have Bacterial Peritonitis or Portal Hypertension? How Do I Perform a Paracentesis and Analyze the Results?

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