What kinds of tests or exams led to a diagnosis of ascites?
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How is ascites diagnosed?
The diagnosis of ascites is based on physical examination in conjunction with
a detailed medical history to
ascertain the possible underlying causes since ascites is often considered a
nonspecific symptom for other diseases. If ascites fluid is greater than 500ml,
it can be demonstrated on physical examination by bulging flanks and fluid waves
performed by the doctor examining the abdomen. Smaller amounts of fluid may be
detected by an ultrasound of the abdomen. Occasionally, ascites is found
incidentally by an ultrasound or a CT scan done
for evaluating other conditions.
Diagnosis of underlying condition causing ascites is the most important part
of understanding the reason for a person to develop
ascites. The medical history may provide clues to the underlying cause and
typically includes questions about previous diagnosis of liver disease,
hepatitis infection and its risk factors, alcohol abuse, family history of liver disease,
heart failure, cancer history, and medication history.
Blood work can play an essential role in evaluating the
cause of ascites. A complete metabolic panel can detect patterns of liver
injury, functional status of the liver and kidney, and electrolyte levels. A
complete blood count is also
useful by providing clues to underlying conditions. Coagulation (clotting) panel
abnormalities (prothrombin time) may
be abnormal because of liver dysfunction and inadequate production of clotting
Sometimes the possible underlying causes of ascites may
not be determined based on the history, examination, and review of laboratory
data and imaging studies. Analysis of the fluid may be necessary in order to obtain further
diagnostic data. This procedure is called paracentesis, and it is performed by
trained physicians. It involves sterilizing an area on the abdomen and, with the
guidance of ultrasound, inserting a needle into the abdominal cavity and
withdrawing fluid for further analysis.
For diagnostic purposes, a small amount (20cc, for example) may be enough for
adequate testing. Larger amounts can be withdrawn if needed to reveal symptoms
associated with increased abdominal ascites, up to a few liters (large volume
The analysis is done by sending the collected fluid to
the laboratory promptly after drainage. Typically, the number and components of
white blood cells and red blood cells (cell count), albumin level, gram stain
and culture for any possible organisms, amylase level, glucose, total protein, and cytology
(malignant or cancerous cells) are analyzed in the laboratory. The results are
then analyzed by the treating doctor for further evaluation and determination of
the possible cause of ascites.