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Abdominal fluid analysis
Last reviewed: 06.07.2025
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The total number of leukocytes in ascitic fluid in chronic liver diseases is less than 300 cells in 1 μl (in 50% of cases), neutrophilic leukocytes make up less than 25% (in a third of cases).
In peritonitis of infectious etiology, the total number of leukocytes is more than 500 cells in 1 μl (sensitivity more than 80%, specificity - 98%), neutrophilic leukocytes make up more than 50%.
Microscopic examination reveals erythrocytes in tuberculous peritonitis, thrombosis of the portal veins and mesenteric vessels, malignant tumors of the peritoneum, and traumatic injuries. A large number of leukocytes occurs in purulent peritonitis, and a large number of lymphocytes in chronic tuberculous peritonitis. The presence of atypical cells, especially in the form of clusters, is characteristic of neoplasms of the peritoneum.
Criteria for the diagnosis of penetrating abdominal wounds based on peritoneal lavage data:
- the number of red blood cells is more than 10,000 in 1 µl (more than 5,000 in 1 µl for gunshot wounds);
- the number of leukocytes is more than 500 in 1 µl or the presence of bile, feces, or bacteria when stained according to Gram.
Criteria for the diagnosis of blunt abdominal trauma based on peritoneal lavage data:
- the number of erythrocytes is more than 100,000 in 1 µl;
- the number of leukocytes is less than 500 in 1 µl;
- α-amylase activity is more than 2 times higher than the upper limit of normal.
Criteria for the presence of urine in the abdominal cavity (in the presence of urinary tract fistulas) - the concentration of urea and creatinine in ascitic fluid is more than 2 times higher than in the blood serum.
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