50-year-old man with a history of alcohol abuse was seen in the emergency room f

Question

50-year-old man with a history of alcohol abuse was seen in the emergency room for symptoms of nausea, vomiting, and abdominal pain. On physical exam, the abdomen appeared distended. A computerized tomographic (CT) scan of the abdomen revealed a collection of fluid. About 1200 mL of fluid was drained and portions were sent to the laboratory for analysis. Peripheral blood was collected simultaneously. The laboratory results are listed on the table below:

Serum Glucose

99 g/dL

Serum Total Protein

7 g/dL

Serum Albumin

4.0 g/dL

Serum LDH

60 U/L

Abdominal Fluid

Physical Appearance

Clear, pale yellow

Abdominal Fluid Glucose

100 mg/dL

Abdominal Fluid Total Protein

1.9 g/dL

Total Protein Ratio

0.3

Abdominal Fluid LDH

25 U/L

LDH Ratio

0.4

Abdominal Fluid Albumin

2.4 g/dL

Abdominal Fluid WBC

60/L

Abdominal Fluid RBC

500/L

Abdominal Fluid Differential

Neutrophils 10%

Lymphocytes 80%

Monocytes/Macrophages 10%

Abnormal Mesothelial cells also observed

What type of procedure was performed to drain and collect the fluid and what body cavity was the fluid collected from?

What is an alternative name for the specimen that was collected?

Is the fluid a transudate or an exudate? Why?

What physiologic processes could cause production of this type of fluid?

Serum Glucose

99 g/dL

Serum Total Protein

7 g/dL

Serum Albumin

4.0 g/dL

Serum LDH

60 U/L

Abdominal Fluid

Physical Appearance

Clear, pale yellow

Abdominal Fluid Glucose

100 mg/dL

Abdominal Fluid Total Protein

1.9 g/dL

Total Protein Ratio

0.3

Abdominal Fluid LDH

25 U/L

LDH Ratio

0.4

Abdominal Fluid Albumin

2.4 g/dL

Abdominal Fluid WBC

60/L

Abdominal Fluid RBC

500/L

Abdominal Fluid Differential

Neutrophils 10%

Lymphocytes 80%

Monocytes/Macrophages 10%

Abnormal Mesothelial cells also observed

Explanation / Answer

the fluid was extracted from the peritoneal cavity ( space between the parietal peritoneum (the peritoneum that surrounds the abdominal wall) and visceral peritoneum).the procedure used is called Paracentesis where the liquid is drained using a plastic tube inserted into the abdomen which might last for 6 hours.

The fluid is a serous fluid also known as peritoneal fluid

from the given data :

Serum Albumin

4.0 g/dL

Abdominal Fluid Albumin

2.4 g/dL

Serum-ascites albumin gradient= (serum albumin) (albumin level of ascitic fluid).

=4.0-2.4 g/dl

= 1.6 g/dl

thus since SAAG > 1.2g/dl(established limit)

The fluid is a transudate as a result of increased pressure in the hepatic portal vein, increased capillary permeability and decreased protein concentration((<30 g/L))(given)

Production of this type of fluid might be due to

Serum Albumin

4.0 g/dL

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