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General clinical examination of abdominal fluid
Medical expert of the article
Last reviewed: 05.07.2025
In healthy people, there is a small amount of fluid in the abdominal cavity between the peritoneum layers. In a number of diseases (liver cirrhosis, heart failure), the amount of ascitic fluid can be significant and reach several liters; such fluid is classified as transudates and has all its characteristics. Hemorrhagic exudate is found in cancerous and, less commonly, tuberculous peritonitis, trauma, strangulated hernias, hemorrhagic diathesis, melanosarcomas of the peritoneum, and sometimes liver cirrhosis. In cases of intestinal perforation, gallbladder, the contents of the abdominal cavity may contain an admixture of bile.
For differential diagnostics of ascites caused by malignant neoplasms and ascites in chronic liver diseases, the albumin gradient (the difference between the albumin concentration in the blood serum and that in the ascitic fluid) is used. If it is below 1.1, then in more than 90% of cases ascites is associated with carcinomatosis or tuberculosis of the peritoneum, pancreatitis or diseases of the biliary tract, nephrotic syndrome, intestinal infarction or intestinal obstruction, serositis. The albumin gradient is almost always higher than 1.1 in liver cirrhosis, alcoholic hepatitis, massive metastases to the liver, fulminant liver failure, portal thrombosis, heart failure, fatty hepatosis of pregnancy, myxedema.
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