Peritoneal Fluid Analysis
The serum-ascites albumin gradient (SAAG) is the most useful index for evaluating peritoneal fluid and can help distinguish ascites caused by portal hypertension (cirrhosis, portal vein thrombosis, Budd-Chiari syndrome, etc) from other causes of ascites. SAAG is calculated by subtracting the albumin measure of ascitic fluid from the serum value. In portal hypertension, the SAAG is >1.1 g/dL while ascites from other causes shows a SAAG of less than 1.1 g/dL.
Peritoneal fluid microscopy is a useful test in evaluating the cause of ascites. A diagnostic peritoneal lavage (DPL) is considered positive if any of the following are present 1. >15 mL gross blood 2. RBCs >100,000/mL 3. WBCs >500/mL 4. Bacteria present on Gram Stain
Bacteria and white blood cells, when present in a patient with a history of ascites (usually due to cirrhosis) is highly suggestive of spontaneous bacterial peritonitis.
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