To differentiate pancreatic ascites from ascites secondary to cirrhosis of the liver, the most impoant test is -
Paracentesisis a form of body fluid sampling procedure, generally referring to peritoneocentesis (also called laparocentesis or abdominal paracentesis) in which the peritoneal cavity is punctured by a needle to sample peritoneal fluid The procedure is used to remove fluid from the peritoneal cavity, paicularly if this cannot be achieved with medication. The most common indication is ascites that has developed in people with cirrhosis Indications It is used for a number of reasons: to relieve abdominal pressure from ascites to diagnose spontaneous bacterial peritonitis and other infections (e.g. abdominal TB) to diagnose metastatic cancer to diagnose blood in peritoneal space in trauma For ascites The procedure is often performed in a doctor's office or an outpatient clinic. In an expe's hands it is usually very safe, although there is a small risk of infection, excessive bleeding or perforating a loop of bowel. These last two risks can be minimized greatly with the use of ultrasound guidance. The patient is requested to urinate before the procedure; alternately, a Foley catheter is used to empty the bladder. The patient is positioned in the bed with the head elevated at 45-60 degrees to allow fluid to accumulate in lower abdomen. After cleaning the side of the abdomen with an antiseptic solution, the physician numbs a small area of skin and inses a large-bore needle with a plastic sheath 2 to 5 cm (1 to 2 in) in length to reach the peritoneal (ascitic) fluid. The needle is removed, leaving the plastic sheath to allow drainage of the fluid. The fluid is drained by gravity, a syringe or by connection to a vacuum bottle. Several litres of fluid may be drained during the procedure; however, if more than two litres are to be drained it will usually be done over the course of several treatments. After the desired level of drainage is complete, the plastic sheath is removed and the puncture site bandaged. The plastic sheath can be left in place with a flow control valve and protective dressing if fuher treatments are expected to be necessary. If fluid drainage in cirrhotic ascites is more than 5 litres, patients may receive intravenous serum albumin (25% albumin, 8g/L) to prevent hypotension (low blood pressure).There has been debate as to whether albumin administration confers benefit, but recent reviews repo that it can reduce moality after large volume paracentesis significantly. The procedure generally is not painful and does not require sedation. The patient is usually discharged within several hours following post-procedure observation provided that blood pressure is otherwise normal and the patient experiences no dizziness. Ref Davidson 23rd edition pg 908
Abdominal ultrasound
Computed tomogram (CT) scan
Abdominal paracentesis
Endoscopic retrograde cholangiopancreato- graphy (FRCP)
Miscellaneous