Ascitic fluid

Replace with 8-10 g albumin/L of ascitic fluid removed o Avoid large-volume paracentesis in patients with pre-existing hemodynamic compromise, acute renal insufficiency, active infection, or active upper gastrointestinal bleed. Cautious large-volume paracentesis in patients with tense... 

High-dose diuretics until loss of ascitic fluid o Spironolactone up to 400 enterally daily... 

The goals of treating ascites are to minimize acute discomfort, re-equilibrate ascitic fluid, and prevent SBP. Treatment should modify the underlying disease pathology without directed therapy, fluid will rapidly reaccumulate. 

Long -term antibiotic prophylaxis for SBP decreases mortality in patients with a history of SBP and low-protein ascites [ascitic fluid albumin less than 1 g/dL (less than 10 g/L)]. 

Signs and symptoms of SBP in a patient with cirrhosis and ascites should prompt a diagnostic paracentesis (Fig. 19-4). In SBP, there is decreased total serum protein, elevated white blood cell count (with left shift), and the ascitic fluid contains at least 0.250 x 103/mm3 (0.250 x 109/L) neutrophils. Bacterial culture of ascitic fluid may be positive, but lack of growth does not exclude the diagnosis. 

A value of greater than or equal to 1.1 g/dL (greater than or equal to 11 g/L) identifies portal hypertension as the cause of the ascites with 97% accuracy.22,30 In portal hypertension the ascitic fluid is low in albumin this balances the oncotic pressure gradient with the hydrostatic pressure gradient of... 

All patients with ascites require counseling on dietary sodium restriction. Salt intake should be limited to less than 800 mg sodium (2 g sodium chloride) per day. More stringent restriction may cause faster mobilization of ascitic fluid, but adherence to such strict limits is very difficult. Patients usually respond well to sodium restriction accompanied by diuretic therapy.14,22,31,32 The goal of therapy is to achieve urinary sodium excretion of at least 78 mEq (78 mmol) per day.22 While a 24-hour urine collection provides this information, a spot urine sodium/ potassium ratio greater than 1.0 provides the same information and is much less cumbersome to perform. 

In the case of tense ascites, relief of acute discomfort may be accomplished by therapeutic paracentesis. Often the removal of just 1 to 2 L of ascitic fluid provides relief of pain and fullness. When removing 5 L or more of fluid at once, volume resuscitation with 8 to 10 g of albumin given intravenously should be provided for each liter of fluid removed. If less than 5 L of fluid is removed in a hemodynamically stable patient, albumin is not warranted.22... 

Patients who have previously experienced spontaneous bacterial peritonitis and have low-protein ascites (ascitic fluid albumin less than 1 g/dL [less than 10 g/L]) are candidates for long-term prophylactic therapy. Recommended regimens include either a single trimethoprim-sulfamethoxazole doublestrength tablet 5 days per week (Monday through Friday) or ciprofloxacin 750 mg once weekly.19,46 Any patient who has experienced an episode of variceal bleeding should also receive prophylactic antibiotics. 

Evaluate effectiveness of diuretic therapy with regard to ascitic fluid accumulation and development of peripheral edema. Ask the patient directed questions about abdominal girth, fullness, tenderness, and pain. Weigh the patient at each visit, and ask the patient to keep a weight diary. Assess for peripheral edema at each visit. 

Ascitic fluid usually contains greater than 300 leukocytes/ mm3, and bacteria may be evident on Gram stain of a centrifuged specimen. 

Culture of peritoneal dialysate or ascitic fluid should be positive. 

Antibody. Rat monoclonal antibody 34A was purified from nu/nu mouse ascites fluid as described (79). The 34A was radiolabeled with 125I using IDO-GEN (Pierce, Rockford, IL) method to a specific activity of 2 to 4 x 105 cpm/pg, and conjugated with NGPE as previously described (7). 

Bahrenburg L. On the diagnostic results of the microscopical examination of the ascitic fluid in two cases of carcinoma involving the peritoneum. Cleve. Med. Gaz. 1896 11 274-278. 

Fluid specimens apply to abdominal washings, ascitic fluids, colonic washings, duodenal washings, gastric washings, pleural fluids, pericardial fluids, ovarian cyst fluids, synovial fluids, and sputa. 

Runyon BA Patients with deficient ascitic fluid opsonic activity are predisposed to spontaneous bacterial peritonitis. Hepatology... 

Gram-positive bacilli on unspun peripheral blood smear or ascitic fluid... 

The best sources of Hp preparations are sera from patients with advanced cancer and/or with severe infections without coexisting abnormal hemolysis, i.e., in subjects with high-electrophoretic a2-values. Sera of the same Hp type may be pooled and stored in the frozen state with no loss of its HbBC, Sera containing Hb visible with the naked eye should not be added to the pools. Ascitic fluid from patients with infections or cancer, but without abdominal hemorrhage, is a convenient source. 

Solubility curves for different types of Hp have been presented (H5, H7). The higher solubility of type 1-1 than that of the others is in conformity with its lower molecular weight. The irregularity of the solubility curves for Hp of 2-2 and 2-1 type reflects the molecular heterogeneity of these two proteins. It is known from fractionation experiments with ammonium sulfate as well as with ethanol that the slower Hp bands are enriched in those Hp fractions that are precipitated first. So far, we have not been able to separate any of the Hp bands completely from the others, except the 1-1 band in ascitic fluid of type 2-1. 

Monoclonal antibodies can be produced not only in a cell culture but also in live animals. When injected into mice (in the peritoneal cavity, the gut), the hybridoma cells produce tumors containing an antibody-rich fluid called ascites fluid. Production in cell culture is usually preferred, as the ascites technique may be very painful to the animal and if replacement techniques exist, may be considered unethical. The process of producing monoclonal antibodies described above was invented by Georges Kohler. Cesar Milstein, and Niels Kaj Jeme in 1975 they shared the Nobel Prize in Physiology or Medicine in 1984 for the discovery (http //en.wikipedia.org/ wiki/Antibody). 

Yamazaki, M., Ikenami, M., Sugiyama, T. (1989). Cytotoxin from polymorphonuclear leukocytes and inflammatory ascitic fluids. Brit. J. Cancer 59,353-5. 

IgG and other proteins from mouse ascites fluid Purification CLC (combination of Anion Exchange and Affinity (Protein A) disks [76]... 

PI. Pagano, M., Dalet-Fumeron, V., and Engler, R., The glycosylation state of the precursors of the cathepsin-iike proteinase from human malignant ascitic fluid Possible implication in the secretory pathways of these proenzymes. Cancer Lett. 45, 13-19 (1989). 

Greco, A. V., Mingrone, G., Gasbarrini, G. Clin. Chim. Acta 239, 1995, 13-22. Free fatty acid analysis in ascitic fluid improves diagnosis in malignant abdominal tumors. 

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