Finding the cause of ascites

Diagnostic paracentesis with ascitic fluid analysis is critical to the accurate diagnosis and management of ascites. Recent advances have improved the evaluation of ascitic fluid, among them the serum-ascites albumin difference for discriminating between ascites caused by liver disease and ascites due to malignancy. The ascitic fluid polymorphonuclear leukocyte concentration is the best index for the rapid presumptive diagnosis of spontaneous bacterial peritonitis. Familiarity on the part of the clinician with ascitic fluid interpretation and with ascitic fluid characteristics in various diseases will increase the chances of controlling ascites early.