Paracentesis

Paracentesis

Illustration of a Paracentesis procedure.

Paracentesis is a medical procedure involving the puncture of the abdominal wall to remove ascitic fluid from the peritoneal cavity. This procedure is primarily used for diagnostic purposes to analyze ascitic fluid in patients with conditions such as ascites, primarily due to cirrhosis, heart failure, or malignancies. Paracentesis can also be therapeutic, providing relief from symptoms associated with fluid accumulation.

Indications

Paracentesis is indicated for:

• Diagnosis of the etiology of new-onset ascites
• Evaluation of patients with known ascites presenting with fever, abdominal pain, or other signs of spontaneous bacterial peritonitis (SBP)
• Relief of discomfort due to significant ascites

Procedure

The procedure involves:

• Pre-procedural assessment including coagulation status
• Patient positioning, typically sitting upright
• Skin sterilization and local anesthesia at the puncture site
• Insertion of a needle or catheter into the peritoneal cavity to withdraw fluid
• Fluid is then sent for analysis, which can include cell count, protein levels, and culture

Diagnostic Significance

Analysis of ascitic fluid can help diagnose:

• Spontaneous bacterial peritonitis (SBP)
• Tuberculosis
• Malignancies
• Portal hypertension related to liver disease

Potential Complications

Though generally safe, paracentesis can occasionally lead to complications such as:

• Bleeding, especially in patients with coagulopathy
• Infection
• Perforation of the bowel
• Hypotension due to rapid removal of large volumes of fluid

Post-procedure Care

Patients typically require monitoring for signs of bleeding or infection post-procedure. In cases of large-volume paracentesis, albumin may be administered to prevent circulatory dysfunction.

See Also

• Ascites
• Spontaneous bacterial peritonitis
• Liver cirrhosis
• Peritoneal cavity

External Links

• National Center for Biotechnology Information - Paracentesis
• UpToDate - Overview of Paracentesis

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